Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

“…30 The HIV prevention continuum consisted of initiation, adherence, and persistence in PrEP care for daily oral TDF/FTC. 4 HIV-negative MSM who met indications for PrEP based on CDC guidelines were eligible to start. 31 Because MSM may enter PrEP care through regular HIV screening or spontaneously, 1 we modeled the link between HIV screening and PrEP in these two ways to understand the relationship between HIV screening and PrEP coverage.…”

Section: Methodsmentioning

confidence: 99%

“…Despite the availability of highly effective HIV prevention tools such as preexposure prophylaxis (PrEP) and treatment as prevention (TasP), antiretroviral therapy (ART) coverage in high-risk populations remains low in many areas in the United States. [1][2][3][4] The new Ending the HIV Epidemic (EHE) plan seeks to reduce HIV incidence nationally by 75% in 5 years (by 2025) and 90% in 10 years (by 2030) by targeting federal resources towards interventions that increase access and uptake of these prevention tools in high-need regions like the Southeast. 5 However, it is unknown what combinations and what amounts of interventions will be needed to meet that goal.…”

Section: Introductionmentioning

confidence: 99%

Modeling an Integrated HIV Prevention and Care Continuum to Achieve the Ending the HIV Epidemic Goals

Jenness

Johnson

Hoover³

et al. 2020

Preprint

View full text Add to dashboard Cite

OBJECTIVE: We sought to evaluate which combinations of HIV prevention and care activities would have the greatest impact towards reaching the US Ending the HIV Epidemic (EHE) plan goals of reducing HIV incidence at least 75% by 2025 and 90% by 2030. DESIGN: A stochastic HIV transmission model for men who have sex with men (MSM), calibrated to local surveillance estimates in the Atlanta area, a focal EHE target jurisdiction. METHODS: Model scenarios varied HIV screening rates relative to current levels, under different assumptions of how HIV-negative MSM would be linked to PrEP initiation, and also considered improvements to HIV care linkage and retention for those screening positive. RESULTS: A 10-fold relative increase in HIV screening rates (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 43% of infections averted if integrated with PrEP initiation. Improvements to HIV care retention would avert 41% of infections if retention rates were improved 10-fold. If both screening and retention were jointly improved 10-fold, up to 74% of cumulative infections would be averted. Under this scenario, it would take 4 years to meet the 75% EHE goal and 12 years to meet the 90% goal for MSM in Atlanta. CONCLUSIONS: Interventions to improve HIV screening linked with PrEP for those screening negative, and HIV care retention would have a substantial impact on HIV prevention. However, additional interventions may be necessary to reach the EHE goal of a 90% reduction in incidence for Atlanta MSM by 2030.

show abstract

“…23,24 PrEP surveillance is crucial in tracking both the overall use of PrEP and disparities in PrEP use among populations at the highest risk of acquiring HIV infection. 9,[12][13][14] Estimates of PrEP use are important for HIV prevention planning, resource allocation, program evaluation, and communication to the public. As such, several federal agencies, academic institutions, state and local health departments, and HIV community-based organizations depend on the accuracy of these data.…”

Section: Lessons Learnedmentioning

confidence: 99%

“…[6][7][8] Furthermore, PrEP use among African American/black persons, Hispanic/Latinx persons, young adults, and persons living in the South is low even though these persons are at the highest risk of HIV. 6,[8][9][10][11][12][13][14] Surveillance of PrEP is needed to track overall PrEP use and identify disparities in use among racial/ethnic groups, sexes, and regions.…”

mentioning

confidence: 99%

Evaluation of Algorithms Used for PrEP Surveillance Using a Reference Population From New York City, July 2016–June 2018

et al. 2020

View full text Add to dashboard Cite

Objective: Daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) use as HIV preexposure prophylaxis (PrEP) is monitored by identifying TDF/FTC prescriptions from pharmacy databases and applying diagnosis codes and antiretroviral data to algorithms that exclude TDF/FTC prescribed for HIV postexposure prophylaxis (PEP), HIV treatment, and hepatitis B virus (HBV) treatment. We evaluated the accuracy of 3 algorithms used by the Centers for Disease Control and Prevention (CDC), Gilead Sciences, and the New York State Department of Health (NYSDOH) using a reference population in Bronx, New York. Methods: We extracted diagnosis codes and data on all antiretroviral prescriptions other than TDF/FTC from an electronic health record database for persons aged ≥16 prescribed TDF/FTC during July 2016–June 2018 at Montefiore Medical Center. We reviewed medical records to classify the true indication of first TDF/FTC use as PrEP, PEP, HIV treatment, or HBV treatment. We applied each algorithm to the reference population and compared the results with the medical record review. Results: Of 2862 patients included in the analysis, 694 used PrEP, 748 used PEP, 1407 received HIV treatment, and 13 received HBV treatment. The algorithms had high specificity (range: 98.4%-99.0%), but the sensitivity of the CDC algorithm using a PEP definition of TDF/FTC prescriptions ≤30 days was lower (80.3%) than the sensitivity of the algorithms developed by Gilead Sciences (94.7%) or NYSDOH (96.1%). Defining PEP as TDF/FTC prescriptions ≤28 days improved CDC algorithm performance (sensitivity, 95.8%; specificity, 98.8%). Conclusions: Adopting the definition of PEP as ≤28 days of TDF/FTC in the CDC algorithm should improve the accuracy of national PrEP surveillance.

show abstract

Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

Cited by 82 publications

References 54 publications

Changes in HIV Preexposure Prophylaxis Awareness and Use Among Men Who Have Sex with Men — 20 Urban Areas, 2014 and 2017

Changes in HIV Preexposure Prophylaxis Awareness and Use Among Men Who Have Sex with Men — 20 Urban Areas, 2014 and 2017

Modeling an Integrated HIV Prevention and Care Continuum to Achieve the Ending the HIV Epidemic Goals

Evaluation of Algorithms Used for PrEP Surveillance Using a Reference Population From New York City, July 2016–June 2018

Contact Info

Product

Resources

About