PrEP is an effective biomedical intervention to prevent HIV transmission; however, uptake among heterosexuals at risk (HET) and people who inject drugs (PWID) recommended for PrEP has not been well-assessed. We used a PrEP continuum to assess the gap in knowledge, access and use of PrEP among HET and PWID in Washington, DC.
We used data from the National HIV Behavioral Surveillance System (NHBS), a community-based cross-sectional survey, collected in 2016 (HET N=503) and 2015 (PWID N=516). Participants were recruited using respondent-driven sampling; weighted percentages are presented. NHBS eligibility for HET included men/women who had sex with an opposite sex partner in the past year; PWID included men/women who reported past year injection drug use. We used CDC criteria to estimate the proportion of HIV-negative/unknown status participants recommended for PrEP use. The PrEP continuum included: ever heard of PrEP, having insurance, ever discussed PrEP with a provider, ever received PrEP or prescription, and ever took PrEP. The number of persons recommended for PrEP was used as the denominator for each continuum step, and the proportion calculated for each step was contingent upon cumulatively meeting all previous steps. Data in the PrEP continuum for both HET and PWID were also examined by gender.
Among HET and PWID in NHBS, 20.8% and 35.2% respectively met the CDC criteria for PrEP; of those, 50.3% of HET and 32.0% of PWID were women. Among HET recommended for PrEP (Figure 1a), only 14.3% had ever heard of PrEP; 11.8% were insured, 1.4% had discussed PrEP with a provider; and <1% ever received PrEP and took PrEP. A higher proportion of HET women versus men had heard of PrEP and were currently insured (p=0.05). Among PWID recommended for PrEP (Figure 1b), 7.4% had ever heard of PrEP; 6.5% were insured; 0.8% had discussed PrEP with a provider; <1% had received PrEP; and none had taken PrEP. Similar proportions of male and female PWID were engaged in the PrEP continuum stages.
A substantial proportion of HET and PWID met the criteria for PrEP utilization, yet a large gap exists at each stage of the PrEP continuum for both groups. Overall PrEP knowledge and utilization was very low in both groups. While a larger proportion of HET women versus men were aware of PrEP and insured, there was no difference in PrEP uptake by gender in either population. New PrEP implementation programs should focus on increasing knowledge and uptake of PrEP in these populations.