Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC.
Ann Epidemiol. 2018 Dec;28(12):841-849. doi: 10.1016/j.annepidem.2018.06.005. Epub 2018 Jun 15.
The number of individuals who have started a regimen for HIV pre-exposure prophylaxis (PrEP) in the United States is not well characterized but has been on the rise since 2012. This analysis assesses the distribution of PrEP use nationally and among subgroups.
A validated algorithm quantifying tenofovir disoproxil fumarate/emtricitabine for PrEP in the United States was applied to a national prescription database to determine the quarterly prevalence of PrEP use. HIV diagnoses from 2016 were used as an epidemiological proxy for PrEP need. The PrEP-to-need ratio (PnR) was defined as the number of PrEP users divided by new HIV diagnoses.
A total of 70,395 individuals used PrEP in the fourth quarter of 2017: 67,166 males and 3229 females. Nationally, prevalence of PrEP use was 26/100,000 (range across states per 100,000 [RAS/100k]: 4-73) and the PnR was 1.8 (RAS: 0.5-6.6). Prevalence of PrEP use among males and females, respectively, was 50/100,000 and 2/100,000 (RAS/100k: 7-143 and 0.3-7) and PnR was 2.1 and 0.4 (RAS: 0.6-7.1 and 0.1-4.0). Prevalence of PrEP use was lowest among individuals aged less than or equal to 24 and more than or equal to 55 years (15/100,000 and 6/100,000, RAS/100k: 1-45 and 0.4-14), with PnR 0.9 and 1.5 (RAS: 0.2-5.6 and 0.3-7.0). The Northeast had the highest PnR (3.3); the South had the lowest (1.0). States with Medicaid expansion had more than double the PnR than states without expansion.
Available data suggest that females, individuals aged less than or equal to 24 years and residents of the South had lower levels of PrEP use relative to epidemic need. These results are ecological, and misclassification may attenuate results. PnR is useful for future assessments of HIV prevention strategy uptake.
在美国，开始接受艾滋病毒暴露前预防（PrEP）治疗的人数尚未得到很好的描述，但自 2012 年以来一直在增加。本分析评估了全国范围内和各亚组中 PrEP 的使用情况。
应用一种经验证的算法来量化美国替诺福韦二吡呋酯/恩曲他滨用于 PrEP 的情况，以国家处方数据库确定 PrEP 的季度使用率。2016 年的艾滋病毒诊断结果被用作 PrEP 需求的流行病学替代指标。PrEP 与需求的比值（PnR）定义为 PrEP 使用者人数与新艾滋病毒诊断人数之比。
2017 年第四季度共有 70395 人使用了 PrEP：67166 名男性和 3229 名女性。全国范围内，PrEP 的使用率为 26/100,000（各州每 100,000 人的范围[RAS/100k]：4-73），PnR 为 1.8（RAS：0.5-6.6）。男性和女性分别有 50/100,000 和 2/100,000 的 PrEP 使用率（RAS/100k：7-143 和 0.3-7），PnR 为 2.1 和 0.4（RAS：0.6-7.1 和 0.1-4.0）。年龄在 24 岁及以下和 55 岁及以上的人群中，PrEP 的使用率最低（15/100,000 和 6/100,000，RAS/100k：1-45 和 0.4-14），PnR 为 0.9 和 1.5（RAS：0.2-5.6 和 0.3-7.0）。东北地区的 PnR 最高（3.3），南部地区最低（1.0）。有医疗补助计划扩张的州的 PnR 是没有扩张的州的两倍多。
现有数据表明，女性、24 岁及以下的人群以及南部地区的人群相对于流行需求，PrEP 的使用率较低。这些结果是基于生态的，可能会因为分类错误而使结果产生偏差。PnR 可用于未来对艾滋病毒预防策略采用情况的评估。
