Abstract
Background
PrEP is an important HIV prevention modality. Population-based metrics of PrEP uptake and access are critical to the evaluation of public health efforts to increase PrEP use.
Methods
Using the Oregon All Payers All Claims administrative dataset, we determined the number of unique individuals at least 16 years of age starting PrEP, defined as at least one prescription of >30 days of Truvada, each year from 2012–2016. People with HIV or hepatitis B were excluded. We created two metrics of PrEP access in 2016: the number of individuals starting PrEP per 100K population and the number of individuals with a PrEP prescription in each of the four quarters of 2016 per 100K population (i.e., prevalent users). Using public health surveillance data, we created three metrics of PrEP need in 2016: the number of HIV diagnoses per 100K population; the number early syphilis and gonorrhea diagnoses per 100K population; and the number of acute or chronic hepatitis C diagnoses among patients aged 16–30 years per 100K population. We calculated six metrics of PrEP access-to-need by dividing each of the access measures by the need measures.
Results
The number of individuals with a new PrEP prescription increased from 8 in 2012 to 571 in 2016. Most new PrEP users were men, aged 25–34 years, identified as white, lived in an urban area, had commercial insurance, and had an internal medicine PrEP prescriber. In 2016, there were 17.2 PrEP starts and 9.9 individuals with a PrEP prescription in all four quarters of 2016 per 100K population. There were 6.7 HIV cases, 136.0 early syphilis and gonorrhea cases, and 109.1 acute and chronic hepatitis C cases per 100K population. Per HIV diagnosis, there were 2.6 PrEP starts and 1.5 prevalent users. However, there were 0.13 PrEP starts and 0.07 prevalent users per early syphilis and gonorrhea diagnosis and 0.16 PrEP starts and 0.09 prevalent users per hepatitis C diagnosis. Women, people aged 16–24, people of color, and people in rural areas experienced lower PrEP access-to-need.
Conclusion
Access metrics based on prevalent users (a measure of longer-term adherence to PrEP), STI diagnoses (a measure of HIV acquisition risk), and HCV diagnoses among those less than 30 years of age (a measure of need among people who inject drugs) may provide a more complete assessment of PrEP access-to-need than those based on PrEP starts and HIV diagnoses.
Disclosures
All authors: No reported disclosures.
Chronic Hepatitis C: An Overview of Evidence on Epidemiology and Management from a Brazilian Perspective
