Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA.
Division of Health Policy and Management, University of California, Berkeley School of Public Health, Berkeley, CA, USA.
AIDS Behav. 2024 Mar;28(3):799-804. doi: 10.1007/s10461-023-04180-3. Epub 2023 Sep 26.
This study quantifies the prevalence and trends in weekly PrEP coverage at the national, state and county-level, before and during the COVID-19 pandemic in the United States.We estimated weekly PrEP coverage using longitudinal individual-level pharmacy claims from IQVIA LRx for a cohort of PrEP users (N = 287,493) ages 16 to 85 years between December 29th, 2019 and November 8th, 2020. Weekly PrEP coverage was defined as PrEP use among individuals at high risk for HIV. We conducted an interrupted time series analysis to quantify changes in weekly PrEP coverage before (December 29th, 2019 - March 8th, 2020) and during (March 29th - November 8th, 2020) the COVID-19 pandemic at the national, state and county-level by county characteristics, specifically by EHE priority jurisdiction, racial/ethnic composition, and urbanity. Nationally, weekly PrEP coverage among individuals ages 16 to 85 at high risk for HIV declined by 11.5% (from 11.0% before to 9.5% during the pandemic; t = 8.02,p < 0.01). Weekly PrEP coverage declined in all states and most counties yet varied substantially across states and counties. Geographic disparities in weekly PrEP coverage were also observed between urban EHE priority counties with significantly lower rates in counties with ≥ 50% Black/Latinx population when compared to their counterparts (7.9% vs. 11.2%; t = 18.91,p < 0.01);these disparities were most pronounced in California and New York. Weekly PrEP coverage was much lower than the 25% annual coverage reported by the Centers for Disease Control and geographic disparities observed within states likely contribute to the persistent racial/ethnic disparities in new HIV diagnoses observed within those states.
本研究在美国量化了在 COVID-19 大流行之前和期间，全国、州和县级每周 PrEP 覆盖的流行率和趋势。我们使用 IQVIA LRx 的纵向个人水平药房数据，对 2019 年 12 月 29 日至 2020 年 11 月 8 日期间年龄在 16 至 85 岁之间的 PrEP 用户队列（N=287493）进行了每周 PrEP 覆盖估计。每周 PrEP 覆盖定义为高危 HIV 人群中的 PrEP 使用。我们进行了中断时间序列分析，以量化在 COVID-19 大流行之前（2019 年 12 月 29 日至 2020 年 3 月 8 日）和期间（2020 年 3 月 29 日至 11 月 8 日），根据县特征（特别是 EHE 优先管辖县、种族/族裔构成和城市化程度），在全国、州和县级层面上，每周 PrEP 覆盖的变化。全国范围内，高危 HIV 人群（年龄在 16 至 85 岁之间）的每周 PrEP 覆盖率下降了 11.5%（从大流行前的 11.0%降至大流行期间的 9.5%；t=8.02，p<0.01）。所有州和大多数县的每周 PrEP 覆盖率都有所下降，但各州和各县之间的差异很大。在城市 EHE 优先县和黑人/拉丁裔人口比例≥50%的县之间，每周 PrEP 覆盖率也存在地理差异，后者的比例明显较低（7.9%比 11.2%；t=18.91，p<0.01）；在加利福尼亚州和纽约州，这些差异最为明显。每周 PrEP 覆盖率远低于疾病控制中心报告的 25%的年度覆盖率，并且州内观察到的地理差异可能导致这些州内新的 HIV 诊断存在持续的种族/族裔差异。
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