Exploring Disparities in Prep Prescriptions for High-Risk HIV Patients Using Real-World Data

OBJECTIVES: Pre-exposure Prophylaxis (PrEP) for HIV is a safe and effective preventative measure, but it is under-prescribed for at-risk individuals. This study seeks to assess the demographics of adult patients that receive PrEP prescriptions versus those who could benefit, and assess the characteristics of hospitals prescribing PrEP.

METHODS: This study used Premier Electronic Health Records Data Set: 1996-2019, an inpatient healthcare database, to assess PrEP prescribing practices from June 2012-2019. The patient population was limited to patients ≥ 18 years. ICD-9-CM and ICD-10-CM codes were used to assess patients that were eligible for PrEP (HIV negative with normal kidney function), who were at increased risk of HIV due to sexual behaviors or practices. Patients taking PrEP medications for post exposure prophylaxis were excluded. The rate of PrEP prescription claims in this population was determined and demographics and characteristics were assessed for those prescribed PrEP (PrEP group) and those without a prescription (no PrEP group). Chi-square tests were used to assess differences between these cohorts between demographic groups.

RESULTS: Out of 611,749 patients that met eligibility criteria, only 0.07% (418 patients) were prescribed PrEP. Chi-squared analysis to assess differences in prescribing practices across patient demographics (age, race, gender, sexuality, and medical insurance status) and hospital characteristics (geographical region, teaching status, urban vs. rural classification, and hospital size: estimated by number of beds) yielded no significant differences between groups (p≥0.32).

CONCLUSIONS: Our data suggest low PrEP prescription rates for eligible inpatient care patients. The lack of statistical significance between demographic groups emphasizes the low prescription rates. Future research could investigate enhancing PrEP access in this setting. Despite immediate patient concerns, inpatient facilities could serve as a resource for providing preventive HIV medication to at-risk individuals.