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HIV pre-exposure prophylaxis provision by U.S. health centers in 2021
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March 1 2024
Chinbunchorn, Tanata; Mayer, Kenneth H.a,b,c; Campbell, Juwanb; King, Danab; Krakower, Douglasb,c,d; Marcus, Julia L.b,d; Grasso, Chrisb; Keuroghlian, Alex S.b,e,f
This is the first analysis of national PrEP prescribing data from health centers across the U.S. and provides important baseline information on health center and patient-population characteristics associated with PrEP prescribing.
Among the 30 million people receiving care at health centers, approximately 0.3% were prescribed PrEP. The total number of patients prescribed PrEP at health centers was 79 163, which suggests that approximately one quarter of national PrEP prescriptions were from health centers. Given the national goal of having 1.2 million people receive PrEP [2], and that health centers in this study serve approximately 9% of the total U.S. population, there should have ideally been at least 108 000 health center patients receiving PrEP. Thus, there was likely inadequate receipt of PrEP prescriptions by health center patients; in fact, one-third of health centers did not report prescribing PrEP in 2021
Abstract
Objectives:
The aim of this study was to assess HIV preexposure prophylaxis (PrEP) provision in U.S. health centers.
Design:
The U.S. Ending the HIV Epidemic (EHE) initiative designated health centers as the main healthcare system through which PrEP scale-up occurs. Health centers offer primary care to over 30 million disproportionately uninsured, racially or ethnically minoritized, and low-income patients. This study is the first to assess PrEP provision across health centers, including characteristics of clinics, patient populations, and policies associated with PrEP prescribing.
Methods:
The Health Resources and Services Administration's Uniform Data System contained aggregate data on PrEP prescriptions and patient sociodemographics at health centers from January 1 through December 31, 2021, in 50 U.S. states, the District of Columbia, and eight U.S. territories. We compared patient demographics and availability of Medicaid expansion and PrEP assistance programs at health centers that prescribed vs. those that did not prescribe PrEP.
Results:
Across 1375 health centers serving 30 193 278 patients, 79 163 patients were prescribed PrEP. Health centers that prescribed any PrEP had higher proportions of sexual, gender, racial, and ethnic minority patient populations compared with health centers that prescribed no PrEP. Compared with health centers that prescribed no PrEP, a higher proportion of health centers that prescribed PrEP were located in designated high-priority jurisdictions of the EHE initiative or states with Medicaid expansion or public PrEP assistance programs.
Conclusion:
Health centers are critical for scaling up PrEP in minoritized populations disproportionately affected by HIV, facilitated through federal and state-level policies. These findings highlight service gaps and inform future interventions to optimize PrEP implementation and support EHE initiative goals
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