Cumulative unique persons starting oral TDF/FTC for PrEP in the United States since 2012, including those actively on PrEP and those who have discontinued PrEP, is estimated to be 140,000. This study is the first to describe the magnitude and distribution of active PrEP prescriptions.
Data on active PrEP prescriptions, defined as ≥1 day of PrEP in Q2 2017 for unique persons, were generated from a national prescription database. An algorithm that includes a minimum 30 day prescription period was used to identify each TDF/FTC for PrEP prescription. Active PrEP prescriptions were calculated per population (PrEP prevalence) by region, gender, and age. HIV diagnoses from 2016, based on CDC surveillance data, were used as an epidemiological proxy for PrEP need. The ratio of PrEP prescriptions per new HIV diagnosis (PrEP-to-need ratio) was used to describe the distribution of prescriptions relative to need.
A total of 61,298 unique individuals had active PrEP prescriptions: 58,603 male and 2,695 female; 6,422 aged ≤24; 24,144 aged 25-34; 15,197 aged 35-44; 10,786 aged 45-54; and 4,866 aged ≥ 55. Nationally, PrEP prevalence was 23.2/100,000 and the PrEP-to-need ratio was 1.5. Males had higher prevalence (45.5/100,000) than females (2.0/100,000), and more than four times the PrEP-to-need ratio (1.8 and 0.4). Persons aged ≤24 had low prevalence (12.3/100,000) and low PrEP-to-need ratio (0.8). The Northeast region had the highest prevalence (38.5/100,000), and the Midwest (18.7/100,000) and South (18.8/100,000) the lowest. The PrEP-to-need ratio was three times higher in the Northeast (2.9) than in the South (0.9). States with Medicaid expansion had higher prevalence (27.0/100,000) than states without expansion (17.1/100,000), and more than double the PrEP-to-need ratio (2.1 and 0.9).
Compared to cumulative starts, active PrEP prescriptions serve as a better indicator of persons potentially receiving protective effects of TDF/FTC for PrEP. Both active PrEP prescription prevalence and PrEP-to-need ratios had substantial variation. Females, persons under 25, residents of the Southern region, and residents of non-Medicaid expansion states all received fewer prescriptions per capita and lower levels of prescription in comparison to epidemic need. The PrEP-to-need ratio may be useful for future assessments of health disparities.