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INCREASING PrEP UPTAKE, PERSISTENT DISPARITIES IN AT-RISK PATIENTS IN A BOSTON CENTER
Kenneth H. Mayer1, Chris Grasso1, Kenneth Levine1, Douglas Krakower2, Victoria Powell2, Stephen L. Boswell1, Julia L. Marcus3
1Fenway Health, Boston, MA, USA,2Beth Israel Deaconess Medical Center, Boston, MA, USA,3Harvard University, Cambridge, MA, USA
Although HIV pre-exposure prophylaxis (PrEP) was approved for high-risk persons in 2012, uptake was initially, slow and some groups were underrepresented among PrEP users. Centers caring for large numbers of high-risk people can facilitate monitoring trends and disparities in PrEP use.
A cross-sectional study was conducted in a Boston community health center (CHC) with the most PrEP experience in New England. For each year during 2012-2016, data were analyzed from potential PrEP candidates – i.e., HIV-uninfected patients screened for rectal sexually transmitted infections (STIs). Chi-square tests were used to compare demographic characteristics between patients who were and were not prescribed PrEP each year, and to test for trends over time.
In 2012, 2.3% of 681 patients screened for rectal STIs were prescribed PrEP, whereas by 2016, 49% of 3333 were (P<0.001). Among rectally screened patients, PrEP use increased over time for all age, gender, race/ethnicity, and insurance type subgroups, except for cisgender women (P=0.32). PrEP uptake was consistently lower among younger patients screened for rectal STIs, with only 34% aged <25 years prescribed PrEP in 2016 compared with 53% of those aged ≥25 years (P<0.001). PrEP users were mostly White in all years, but PrEP uptake was highest in Hispanic patients in 2014-2016; in 2016, PrEP use was 39% and 41% among Asian and Black patients screened for rectal STIs, compared with 51% and 55% among White and Hispanic patients, respectively (P<0.001). All PrEP users were cisgender males in 2012; by 2016, 2.9% were transgender and 0.1% were cisgender women. Among rectally screened patients in 2016, 53% of cisgender males used PrEP compared with 21% of transgender patients and 1.7% of cisgender women (P<0.001). In 2016, a higher proportion of PrEP users had private insurance (82% vs. 76%) and a lower proportion had Medicaid or other public insurance (6.9% vs. 12%) compared with non-PrEP users (P<0.001). Among rectally screened patients in 2016, PrEP use ranged from 40% among those with Medicaid or other public insurance to 55% among privately insured patients (P<0.001).
PrEP uptake increased steeply at a Boston CHC, but in 2016, nearly half of rectally screened patients were not using PrEP, and disparities in uptake persisted. Strategies are needed to mitigate barriers to PrEP use among racial/ethnic minorities, cisgender and transgender women, and younger and underinsured individuals.