CDC Finds PrEP Not Reaching Americans Who Need It, Particularly African Americans

Since its approval in 2012, pre-exposure prophylaxis (PrEP) has helped prevent HIV-infections in countless individuals around the world. When taken consistently, PrEP has been shown to reduce the risk of infection by about 92% in men; however, the pill does not seem to be reaching enough Americans who need it, according to a new Centers for Disease Control and Prevention (CDC) study.

At the 25th Conference on Retroviruses and Opportunistic Infections (CROI), Dawn K. Smith, MD, MPH, MS, epidemiologist and medical officer in the CDC’s Division of HIV/AIDS Prevention, shared findings from a recent CDC analysis that identified where PrEP gaps are greatest with the hope that the research will assist providers and partners across the nation in targeting education and other efforts to increase the number of individuals offered this preventive strategy.

“The analysis that I presented combines new CDC estimates of PrEP needs by race and risk group, along with an examination of available data on PrEP uptake from a national database of prescriptions filled by commercial pharmacies in the United States,” Dr. Smith said during a press conference on the study. “Combining these data sets allows us to take the first detailed look at coverage by race and we found that the gap is greatest among people of color, especially African Americans and Latinos.”

In fact, the analysis found that about half of the number of individuals who could potentially benefit from PrEP (defined by CDC clinical guidelines) are African Americans, and they are “by far, the least likely to have a prescription,” according to Dr. Smith. Although racial and ethnic data were not available for about one-third of prescription data, the analysis clearly illustrated “a substantial unmet prevention need,” she said.

For example, the data suggest that of the approximately 500,000 African Americans identified as those who could potentially benefit from PrEP, only 1% (7000) filled their prescriptions from September 2015 to August 2016. Furthermore, only 3% (7600) of Latinos filled prescriptions during that time period. Although the gap between those who could benefit from PrEP and those who actually received it was smaller among white individuals, still, only 14% (42,000) of the 300,000 white individuals identified to potentially benefit from PrEP filled their prescriptions during that time.

The study data also provided new national estimates of “how many Americans, overall, had indications for PrEP in 2015, as well as breakdowns, not only by race/ethnicity, but also by risk group,” shared Dr. Smoth. CDC researchers used a new method to get these estimates that combined data on both risk behavior and the latest information available regarding HIV diagnoses nationally, and by state.

“We know that it in addition to risk behavior, the prevalence of HIV in the communities plays an important role in a person’s likelihood of infection, and so, by accounting for this, the new method gives us a much clearer picture of where the potential impact would be greatest,” Dr. Smith explained.

Using this model, CDC researchers found that in 2015, on a national level, about 1.1 million Americans could potentially benefit from PrEP; this number includes 800,000 gay and bisexual men, 250,000 heterosexuals, and about 70,000 injection drug users. “While today, I only presented national-level estimates, the new method will also allow us to provide state-by-state estimates,” Dr. Smith said. “We believe that once available the data will help states more effectively target their efforts locally.”

What can health providers do to address this gap and ensure that individuals who could benefit from PrEP are linked with the medication? Dr. Smith says that performing routine, or frequent testing is key, as the first step in PrEP is to determine an individual's status. Providers should also "find ways to collect risk behavior data that fit within [their] clinic and that can be done simply or quickly,” she said. “That can be having the nurse ask a couple of questions before you see the patient or that can be adding some questions to that form that we all fill out when we all go in that says, ‘Do you smoke? Etc.’” Providers should try to help their patients acknowledge if they are engaging in risky behaviors that could potentially expose them to the virus, which means they need to ask those important questions.

“I think that providers need to do a better job of finding ways to quickly and simply determine which patients in their practice may need PrEP,” Dr. Smith stressed. “An easy way to do that is to [identify which patients] in your practice have sexually transmitted infections (STIs).” To look for a history of past STIs, providers can turn to their patients’ medical records.

The study underscores the urgent need to increase awareness of and access to PrEP, Dr. Smith concluded, especially among African American and Latino populations.