Trends in HIV pre-exposure prophylaxis use in eight Canadian provinces, 2014–2018

Abstract

Introduction: Canada has endorsed the Joint United National Programme on HIV and AIDS global targets to end the acquired immunodeficiency syndrome (AIDS) epidemic, including reducing new human immunodeficiency virus (HIV) infections to zero, by 2030. Given the effectiveness of pre-exposure prophylaxis (PrEP) to prevent new infections, it is important to measure and report on PrEP utilization to help inform planning for HIV prevention programs and policies. Methods: Annual estimates of persons using PrEP in Canada were generated for 2014–2018 from IQVIA’s geographical prescription monitor dataset. An algorithm was used to distinguish users of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for PrEP versus treatment or post-exposure prophylaxis. We provide the estimated number of people using PrEP in eight Canadian provinces by sex, age group, prescriber specialty and payment type. Results: The estimated number of PrEP users increased dramatically over the five-year study period, showing a 21-fold increase from 460 in 2014 to 9,657 in 2018. Estimated PrEP prevalence was 416 users per million persons across the eight provinces in 2018. Almost all PrEP users were male. Use increased in both sexes, but increase was greater for males (23-fold) than females (five-fold). Use increased across all provinces, although there were jurisdictional differences in the prevalence of use, age distribution and prescriber types. Conclusion: The PrEP use in Canada increased from 2014 to 2018, demonstrating increased awareness and uptake of its use for preventing HIV transmission. However, there was uneven uptake by age, sex and geography. Since new HIV infections continue to occur in Canada, it will be important to further refine the use of PrEP, as populations at higher risk of HIV infection need to be offered PrEP as part of comprehensive sexual healthcare.

Roll-out of HIV pre-exposure prophylaxis use in France: A nationwide observational study from 2016 to 2021

“…To date, available data on PrEP use in real-life were restricted to specific subgroups in France. 23 , 32 , 34 Several representative studies on PrEP use and users characteristics were conducted in other countries 35 , 36 , 37 , 38 , 39 , 40 but did not cover the period of the COVID-19 pandemic which had a significant impact on access to prevention services, including PrEP. 11 , 12 , 13 Large scale, real-life studies assessing PrEP number of users and patterns of use, such the one presented here, are essential to guide health authorities in promoting the use of PrEP.…”

Measuring progress towards reaching zero new HIV acquisitions among key populations in Québec (Canada) using routine surveillance data: a mathematical modelling study

“…Although we do not model the impact of ART on transmission directly, its successful scale‐up likely played a part in the incidence declines over the last decade. Moreover, pre‐exposure prophylaxis (PrEP) was introduced for MSM in 2013 and could have accelerated incidence reductions, especially amidst increased usage in recent years [42,43], where coverage (i.e. those currently on PrEP) rose from 5% to 10% between 2017 and 2018 in Montréal [43].…”

Pre-exposure prophylaxis for HIV: effective and underused

“…Preexposure prophylaxis was used off label until Health Canada approved daily TDF/FTC for PrEP in 2016, lowercost generic versions became available in 2017 and the Canadian guideline was released in 2017. 2,6,32 A study of prescription data in 8 provinces estimated that 9657 patients were receiving PrEP in 2018, about 98% of whom identified as male. 32 from 44.9% to 58.1%, yet only 14.5%-21.8% had used PrEP.…”

“…2,6,32 A study of prescription data in 8 provinces estimated that 9657 patients were receiving PrEP in 2018, about 98% of whom identified as male. 32 from 44.9% to 58.1%, yet only 14.5%-21.8% had used PrEP. 3 Even among GBM at elevated risk of HIV, only 24.6% were taking PrEP in 2017.…”

“…4 In 2018, women made up 25% of new HIV diagnoses yet accounted for only 2% of PrEP users in Canada. 1,32 Minimal data on uptake in other populations are available.…”