Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition — United States, 2015

Smith, Dawn K.; Handel, Michelle Van; Wolitski, Richard J.; Stryker, Jo Ellen; Hall, H. Irene; Prejean, Joseph; Koenig, Linda J.; Valleroy, Linda A.

doi:10.15585/mmwr.mm6446a4

Cited by 316 publications

(250 citation statements)

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“…The CDC estimates that about 1.2 million persons in the U.S. are eligible for PrEP. 9 Although we do not know the exact proportion of PCPs who provide care to persons eligible for PrEP, the fact that the vast majority of persons who are eligible are not receiving PrEP underscores the need to increase the number of PCPs offering PrEP to eligible individuals. 10 Second, as PCPs providing care to greater than 50 HIV-positive patients were more likely to report PrEP adoption than those providing no HIV care, provider-focused educational initiatives to enhance PrEP adoption may need to target those without HIV care experience, as well as training those with HIV care experience to be PrEP "clinical champions".…”

Section: Discussionmentioning

confidence: 99%

“…2 The CDC estimates that 1.2 million individuals are eligible for PrEP based on sexual and drug use behaviors, yet only about 80,000 unique individuals have been prescribed PrEP since its 2012 approval by the Food and Drug Administration. 9,10 Moreover, studies suggest that only a minority of U.S. health care providers report having ever prescribed PrEP. [11][12][13][14][15][16][17] Health care providers play a central role in the implementation of new health-related technologies, given their access to individuals or populations that might benefit most.…”

Section: Introductionmentioning

confidence: 99%

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A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians

et al. 2016

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BACKGROUND: Among health care providers, prescription of HIV pre-exposure prophylaxis (PrEP) has been low. Little is known specifically about primary care physicians (PCPs) with regard to PrEP awareness and adoption (i.e., prescription or referral), and factors associated with adoption. OBJECTIVE: To assess PrEP awareness, PrEP adoption, and factors associated with adoption among PCPs. DESIGN: Cross-sectional online survey conducted in April and May 2015. RESPONDENTS: Members of a national professional organization for academic primary care physicians (n = 266). MAIN MEASURES: PrEP awareness, PrEP adoption (ever prescribed or referred a patient for PrEP [yes/no]), provider and practice characteristics, and self-rated knowledge, attitudes, and beliefs associated with adoption. KEY RESULTS: The survey response rate was 8.6 % (266/2093). Ninety-three percent of respondents reported prior awareness of PrEP. Of these, 34.9 % reported PrEP adoption. In multivariable analysis of provider and practice characteristics, compared with non-adopters, adopters were more likely to provide care to more than 50 HIV-positive patients (vs. 0, aOR = 6.82, 95 % CI 2.06-22.52). Compared with non-adopters, adopters were also more likely to report excellent, very good, or good selfrated PrEP knowledge (15.1 %, 33.7 %, 30.2 % vs. 2.5 %, 18.1 %, 23.8 %, respectively; p < 0.001) and to perceive PrEP as extremely safe (35.1 % vs. 10.7 %; p = 0.002). Compared with non-adopters, adopters were less likely to perceive PrEP as being moderately likely to increase risk behaviors ("risk compensation") (12.8 % vs. 28.8 %, p = 0.02). CONCLUSIONS: While most respondents were aware of PrEP, only one-third of PrEP-aware PCPs reported adoption. Adopters were more likely to have experience providing HIV care and to perceive PrEP as extremely safe, and were less likely to perceive PrEP use as leading to risk compensation. To enhance PCP adoption of PrEP, educational efforts targeting PCPs without HIV care experience should be considered, as well as training those with HIV care experience to be PrEP "clinical champions". Concerns about safety and risk compensation must also be addressed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians

et al. 2016

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“…By 2015, Truvada® had the largest market share (17%) of all HIV drugs with no competing HIV drugs on the market for prophylaxis. The potential market for PrEP is estimated as 1.2 million people, including 25% of the estimated 4.5 million men who have sex with men (MSM) in the US [10][11][12]. The 2 of 18 average wholesale price of Truvada® was $1,646 for a 30-day supply in 2015 whether used for prevention or treatment of HIV [13].…”

Section: Introductionmentioning

confidence: 99%

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

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This economic evaluation aims to support policy-making on the combined use of preexposure prophylaxis (PrEP) with HIV vaccines by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices,PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER=$463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. Results suggest that boosting potential may be key to HIV vaccine value.

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“…Compare those initial prevention responses to subsequent approaches, informed by theory and evidence, that tested interventions based on theoretically derived models of behavior change, delivered by engaging the social networks of vulnerable populations [5]. Or reckon how randomized controlled trials have demonstrated the efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV infection among men who have sex with men [6] as well as heterosexual men and women [7]; if brought to scale and provided in tandem with other effective HIV prevention methods, there is little doubt that PrEP could substantially reduce the number of new HIV infections among at-risk populations [8].…”

mentioning

confidence: 99%

When Science and Values Collide: Recalling the Lessons of Evidence-Based HIV Prevention

2017

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Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition — United States, 2015

Cited by 316 publications

References 10 publications

A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians

A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

When Science and Values Collide: Recalling the Lessons of Evidence-Based HIV Prevention

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