Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL, USA.
Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA.
J Gen Intern Med. 2023 Feb;38(2):382-389. doi: 10.1007/s11606-022-07687-y. Epub 2022 Jun 9.
HIV incidence remains high in the U.S. as do disparities in new HIV diagnosis between White and Black populations and access to preventive therapies like pre-exposure prophylaxis (PrEP). The federal Ending the HIV Epidemic (EHE) initiative was developed to prioritize resources to 50 jurisdictions with high HIV incidence.
We conducted secondary analyses of data (2013-2019) from the CDC, Census Bureau, and AIDSVu to evaluate the correlation between PrEP use, HIV incidence, and HIV incidence disparities. We compared the PrEP-to-need ratio (PnR) with the ratio of Black and White HIV incidence rates in 46 EHE counties. Subsequent analyses were performed for the seven states that contained multiple EHE counties.
These 46 counties represented 25.9% of the U.S. population in 2019. HIV incidence ranged from 10.5 in Sacramento County, CA, to 59.6 in Fulton County, GA (per 100,000). HIV incidence disparity ranged from 1.5 in Orleans Parish, LA, to 12.1 in Montgomery County, MD. PnR ranged from 26.8 in New York County, NY, to 1.46 in Shelby County, TN. Change in HIV incidence disparities and percent change in PnR were not significantly correlated (ρ = 0.06, p = 0.69). Change in overall HIV incidence was significantly correlated with increase in PnR (ρ = -0.42, p = 0.004).
PrEP has the potential to significantly decrease HIV incidence; however, this benefit has not been conferred equally. Within EHE priority counties, we found significant HIV incidence disparities between White and Black populations. PrEP has decreased overall HIV incidence, but does not appear to have decreased HIV incidence disparity.
在美国，HIV 发病率仍然很高，白人和黑人之间新的 HIV 诊断率存在差异，并且获得预防疗法（如暴露前预防[PrEP]）的机会也存在差异。联邦终结艾滋病毒流行（EHE）倡议旨在优先为 HIV 发病率高的 50 个司法管辖区分配资源。
我们对来自疾病预防控制中心、人口普查局和 AIDSVu 的数据（2013-2019 年）进行了二次分析，以评估 PrEP 使用、HIV 发病率和 HIV 发病率差异之间的相关性。我们将 PrEP 需求比（PnR）与 46 个 EHE 县的黑人和白人 HIV 发病率进行了比较。随后对包含多个 EHE 县的七个州进行了分析。
这 46 个县占 2019 年美国人口的 25.9%。HIV 发病率从加利福尼亚州萨克拉门托县的 10.5 到佐治亚州富尔顿县的 59.6（每 10 万人）不等。HIV 发病率差异从路易斯安那州奥尔良教区的 1.5 到马里兰州蒙哥马利县的 12.1 不等。PnR 从纽约州纽约县的 26.8 到田纳西州谢尔比县的 1.46 不等。HIV 发病率差异的变化与 PnR 的百分比变化没有显著相关性（ρ=0.06，p=0.69）。总体 HIV 发病率的变化与 PnR 的增加显著相关（ρ=-0.42，p=0.004）。
PrEP 有可能显著降低 HIV 发病率；然而，这种益处并没有平等地体现。在 EHE 优先县内，我们发现白人和黑人之间存在显著的 HIV 发病率差异。PrEP 降低了总体 HIV 发病率，但似乎并未降低 HIV 发病率差异。
