Background: Although pre-exposure prophylaxis (PrEP) has been recommended by the CDC to prevent HIV transmission among men who have sex with men (MSM) and heterosexuals who engage in condomless sex with HIV-infected and/or high risk partners, prior reports have suggested low uptake by key US populations.
Methods: Fenway Health (FH), a Boston community health center which has specialized in sexual and gender minority primary care since 1971 has used an electronic medical record (EMR) to document clinical encounters since 1997. EMRs of HIV-uninfected patients who were prescribed Tenofovir/Emtricitabine for more than one month were reviewed. Time trend analyses were calculated to examine the presence of upward trends for: 1) the total number of PrEP prescriptions, annually, from 2011 to 2014, 2) ethnic/racial diversity, and 3) age distributions of PrEP users.
Results: Six patients (pts) were prescribed PrEP in 2011; 23 in 2012; 104 in 2013; 326 by 9/20/2014 (upward trend; p<0.05). Although all pts who were prescribed PrEP were White in 2011, by 2014, 8.8% of PrEP users were Black pts and 20.9% were from other racial or ethnic groups (upward trend; p<0.05). In 2011, 50% of PrEP users were < 30 years old (y.o.); in 2014, 40.5% of PrEP users were <30 y.o. Almost all PrEP users were MSM, with only 1 heterosexual man, 2 women and 16 transgender persons being prescribed PrEP at FH since 2011. Over 4/5 (84.1%) of prescriptions were covered by commercial insurance, with 5.0% covered by Medicare and 5.7% by Medicaid. More than 40 providers were involved in the care of at least one PrEP pt, with the largest PrEP census by provider being 52. In EMR review, 36 PrEP pts had been in a prior PrEP study; 61 had a bacterial STD diagnosed within 60 days of initiating PrEP, and 113 had used post-exposure prophylaxis (PEP) previously. Thus far, only one pt prescribed PrEP became HIV-infected; this occurred very soon after initiating PrEP.
Conclusions: PrEP uptake has increased among MSM pts in a Boston community health center over the past 3 years, with the greatest increase in recent months. The racial/ethnic diversity of PrEP users has increased, with a large proportion of PrEP pts being < 30 y.o. Although some patients continued using PrEP after being in a research study, more PrEP pts were prescribed PrEP after a recent STD or after having used PEP, without prior PrEP experience. These findings suggest increased FH clinician and MSM pt acceptance of PrEP as part of a comprehensive HIV prevention package.