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  53rd ICAAC Interscience Conference on
Antimicrobial Agents and Chemotherapy
September 10-13, 2013, Denver CO
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Almost Half of Early US PrEP Are Women, Often in Southern States
  53rd ICAAC, September 10-13, 2013, Denver
Mark Mascolini
Women accounted for 48% of Truvada pre-exposure prophylaxis (PrEP) prescriptions in the United States through March 2013, according to analysis of a nationally representative sample [1]. People living in the South filled one third of US Truvada PrEP prescriptions.
Truvada (single-tablet tenofovir/emtricitabine) won approval for use as a daily pill to prevent HIV infection in July 2012. Discussion of PrEP grew intense when randomized trials found that daily Truvada prevents HIV in high-risk people who take the pill regularly, but early anecdotal evidence suggested low PrEP demand in the United States immediately after licensing [2].
To begin calculating actual Truvada PrEP uptake and to determine which US groups are more likely to try PrEP, Gilead Sciences researchers used nationally representative anonymous consumer data gathered from prescriptions filled at about 55% of all US pharmacies. Data available from this source included medical claims, patient and provider demographics, and lab data. The investigators developed an algorithm to separate Truvada PrEP prescriptions from Truvada prescriptions for HIV therapy, postexposure prophylaxis, and off-label treatment of hepatitis B infection.
From January 2011 through March 2013, this search identified 1774 people who started Truvada PrEP. The small contingent of 150 PrEP users identified in 2011 (before licensing) expanded 8.5-fold to 1274 users in 2012. Through the first 3 months of 2013, another 350 people started Truvada PrEP. If that last rate holds for the rest of 2013, 1400 people will start PrEP in 2013. Those 1400 would represent 3% of the estimated 50,000 US residents who get infected with HIV yearly.
Almost half of PrEP users identified so far, 47.7%, are women. The proportion of PrEP users who are women changed from 28.7% in 2011, to 50.5% in 2012, and to 45.7% in the first 3 months of 2013. PrEP takers have a median age of 37 years (interquartile range 29 to 48), and only 13.6% are under 25. The median age of PrEP starters fell from 43.7 in 2011 to 38.7 in 2013.
People living in the South account for 32% of PrEP prescriptions so far, followed by people in the Northeast and West (24% each) and people in the Midwest (18%). Six medical specialties wrote three quarters of identified PrEP prescriptions, led by family practice (16%), internal medicine (15%), emergency medicine (14%), infectious diseases (12%), nurse practitioners (9%), and physician assistants (8%). If those last two groups are combined, nonphysicians would make up the biggest prescribing group. PrEP prescribers live in 49 states and about 700 cities. Among 1674 prescribers, only 620 (37%) also prescribed Truvada for treatment.
Compared with HIV-positive people taking Truvada for treatment, people taking Truvada to prevent HIV infection were almost 1.8-fold as likely to be women (95% confidence interval [CI] 1.7 to 2.0), 3.8 times as likely to be treated by someone other than an infectious disease physician (95% CI 3.3 to 4.2), 40% as likely to be younger than 25 (95% CI 1.2 to 1.6), and 40% as likely to live in the South (95% CI 1.3 to 1.6) (P < 0.01 for all comparisons).
1. Rawlings K, Mera R, Pechonkina A, et al. Status of Truvada for HIV pre-exposure prophylaxis (PrEP) in the United States: an early drug utilization analysis. 53rd ICAAC. September 10-13, 2013. Denver. Abstract H-663a.
2. How PrEP will roll out in practice (slowly, so far). An interview with Raphael J. Landowitz, MD, MSc. Research Initiative, Treatment Action. 2012;17(2):34-40. http://centerforaids.org/pdfs/ritawinter2012.pdf