PrEP Use Growing in the US and Worldwide

A new study suggests that the use of pre-exposure prophylaxis (PrEP) for HIV prevention has increased both in the US and worldwide. PrEP use has grown even faster among men who have sex with men (MSM), for whom the odds of reporting any PrEP use has doubled each year since FDA approval in 2012.

The results were recently published online in AIDS.¹

“The most recent strategic plan released by the CDC’s Division of HIV/AIDS Prevention in 2017 set the objective to increase the number of PrEP users by at least 500% by 2020. . . . [I]f current efforts to promote effective PrEP use are maintained, we may see maximum coverage of PrEP use within several years and may meet these assertive U.S. national objectives,” wrote first author Emiko Kamitani, MD, PhD, of the CDC in Atlanta, GA, and colleagues.

Comprehensive review of PrEP use
The study is the first published review of self-reported PrEP use in the US and globally. A previous study had shown that about 120,000 people in the US were using PrEP in 2017.² But that study included only data from retail pharmacies and may have left out institutionalized individuals or those in the Veterans Affairs system. The CDC estimates that about 1.2 million people in the US met indications for PrEP in 2015.³

The current study drew on data from research studies and may present a more comprehensive estimate of PrEP use in the US and worldwide. Researchers searched four databases for English-only articles about PrEP use both in the US and abroad. The analysis included 72 studies published between 2006 and 2018, most of which were US-based (n = 55) and had sample sizes ranging from 30 to 6483. The analysis pooled study results to estimate prevalence rates of PrEP use.

Key results
• Globally: 2.6% reported ever using PrEP
– Odds of PrEP use significantly increased by 1.6 times each year since 2012 (P < .00001)

• US: 3.4% reported ever using PrEP
– Odds of reporting PrEP use grew 1.8 times per year since 2012 (P < .00001)

• MSM in the US: 5% reported ever using PrEP
– Odds of reporting any PrEP use doubled each year since 2012 (P < .00001)

• 17.3% of US study participants and 24.5% of MSM who met CDC’s PrEP indications reported ever using PrEP by 2016

Please click below for discussion of the results and the take-home points.

Discussion
The authors mentioned several limitations. Too few studies reported on PrEP use in heterosexuals or injection drug users, so analyses could not be conducted for these groups. In addition, PrEP use was self-reported in all studies and may indicate past but not current use. Finally, results are limited to published studies only and may not necessarily represent actual rates in the community.

Take-home points
• Review of study data showed self-reported PrEP use has grown between 1.6 times per year globally and 1.8 times per year in the US since FDA approval in 2012

• The growth rate of PrEP use among MSM in the US is even higher and has approximately doubled each year since 2012

• Almost 1 in 6 US-based study participants and almost 1 in 4 MSM who met CDC’s PrEP indications reported ever using PrEP by 2016

References:

1. Kamitani E, Wichser ME, Adegbite AH, et al. Increasing prevalence of self-reported HIV pre-exposure prophylaxis (PrEP) use in published surveys - a systematic review and meta-analysis. AIDS. 2018 Aug 8. doi: 10.1097/QAD.0000000000001983.

2. Mera Giler R, Magnuson D, Trevor H, et al. Changes in Truvada (TVD) for HIV pre-exposure prophlaxis (PrEP) unilization in the United States: (2012-2016). Presented at the 9th IAS Conference on HIV Science (IAS 2017). Paris, France; 2017. Accessed August 20, 2018.

3. Smith DK, Van Handel M, Wolitski RJ, et al. Vital signs: estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition-United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:1291-1295. doi: 10.15585/mmwr.mm6446a4.