Background:
HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) are effective HIV prevention interventions. PEP is the only intervention that can reduce the likelihood of HIV acquisition after exposure, yet U.S. population-level estimates of PEP are lacking. Our objective was to estimate trends in the number of persons prescribed PEP and compare with PrEP trends.
Methods:
We analyzed data from IQVIA Real World Data-Longitudinal Prescriptions database, representing 94% of all prescriptions from retail pharmacies in the U.S. We developed an algorithm to identify persons aged ≥16 years prescribed PEP between 2013−2022. We estimated the number of PEP users each year, stratified by sex, age, payer type, region, and prescriber type and specialty. We assessed trends by calculating the estimated annual percentage change (EAPC) with 95% confidence intervals (CI) and compared with trends in persons prescribed PrEP.
Results:
During 2013−2022, the annual number of PEP prescriptions ranged from 13,999−17,996. Among 16,826 PEP users in 2022, 51.2% were women, 60.1% were aged 25-44 years, 35.6% resided in the South, 37.5% had public insurance paying for their PEP, and 43.1% had private insurance. Among 12,042 PEP prescribers in 2022, 60.4% were physicians, and 38.3% were nurse practitioners or physician assistants. Among physicians, 47.2% were primary care doctors, followed by emergency care doctors (31.0%) and infectious diseases doctors (12.0%). Comparing with trends in number of persons prescribed PrEP (EAPC=33.0%, 95% CI 32.9-33.0), we observed modest increases in number of persons prescribed PEP during 2013-2022 (EAPC=1.4%, 95% CI 1.2-1.5, Figure). PEP increases were uneven between age groups. For persons aged 16-24 years, PEP prescriptions increased from 199 in 2013 to 1,373 in 2022 (EAPC=22.1%; 95% CI: 21.0-23.2); for persons aged 25-34 years, it increased from 1,864 in 2013 to 6,205 in 2022 (EAPC=11.8%; 95% CI: 11.4-12.2).
Conclusions:
We did not observe a consistent trend in PEP prescriptions, unlike the markedly increasing trend in PrEP over the last decade. PEP may be an underutilized tool for HIV prevention, particularly among the groups mostly experiencing new HIV infections. Interventions such as clinical decision support in electronic health systems, provider and population education, and structural interventions are needed to increase PEP use. Interventions to support PEP prescribing are particularly important in the primary care and emergency department clinical settings.
