UPTAKE OF PRE-EXPOSURE PROPHYLAXIS (PREP) AND TYPE OF PROVIDERS AMONG COMMERCIALLY-INSURED PERSONS IN THE UNITED STATES, 2012-2018
Author(s)
Song HJ1, Squires P2, Wilson D1, Lo-Ciganic W1, Cook RL3, Park H1
1University of Florida College of Pharmacy, Gainesville, FL, USA, 2University of Florida College of Pharmacy, GAINESVILLE, FL, USA, 3University of Florida, SHARC Center for Translational HIV Research, Gainesville, FL, USA
OBJECTIVES: The CDC estimated that 1.1 million Americans have an indication for pre-exposure prophylaxis (PrEP), human immunodeficiency virus (HIV) prevention therapy, but uptake is low. We examined trends in the utilization of PrEP and the characteristics of PrEP providers among commercially-insured U.S. persons. METHODS: We identified persons treated with ≥30 days of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) in the Truven Commercial Database (2011-2018). We excluded patients with HIV or hepatitis B virus during the year before the first TDF/FTC prescription date, or HIV post-exposure prophylaxis. We matched pharmacy claims using PrEP fill date with service date of outpatient or inpatient claims for each prescription to identify provider specialty. We compared the number of prescribed persons by provider specialty (primary care physicians [PCPs], infectious diseases, and others) and whether they were HIV care providers. PrEP uptake and provider changes over time were tested using linear regression. RESULTS: The number of persons prescribed PrEP increased 37-fold from 865 in 2012 to 32,102 in 2018 (P<0.01). Most PrEP users were men (95.3%) and half were aged 18-34 years (52%). In 2018, among 9,304 PrEP prescriptions with available provider type information, PCPs prescribed 78.3% and infectious-disease specialists prescribed 6%. Most of the PrEP users (64%) received prescriptions from the 42% of prescribers who had also seen an HIV patient. CONCLUSIONS: Although the number of U.S. commercially-insured PrEP users increased substantially, the PrEP utilization derived from our study indicates that many persons with a PrEP indication still do not receive PrEP care. PCPs prescribed over two-thirds of the PrEP prescriptions and most PrEP users were treated by an HIV care provider. Public health efforts should focus on increasing PrEP access by enhancing provider education to identify appropriate candidates for PrEP, especially PCPs and non-HIV care providers.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PIN57
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care
Topic Subcategory
Prescribing Behavior, Public Health
Disease
Infectious Disease (non-vaccine)