States with low initial use of HIV-prevention drugs fall behind

Aug. 16, 2021

A new study finds that states with low initial use of HIV-prevention drugs are continuing to fall behind in usage among people at risk for the disease, according to a news release from the University of Virginia. 

Researchers, clinicians and advocates had hoped that late-adopting states would see a surge in HIV prevention uptake once those states joined the prevention effort, but that’s largely not the case. Instead, there are worsening disparities between states that backed the drugs early on and those that did not.

The federal government has set a goal of preventing 250,000 HIV infections over 10 years as part its “Plan to End the HIV Epidemic.” Key to that are state and county-level partnerships to encourage use of HIV pre-exposure prophylaxis, or PrEP. These drugs can prevent HIV infection among people at higher risk for HIV, such as people who have condomless sex and people who inject drugs.

Approved in 2012, PrEP has been available for nearly a decade, yet usage remains low. Fewer than 20% of people who would benefit from it are taking it, public health officials estimate.

To better understand the progress of PrEP uptake, researchers at UVA Health compared the number of people with PrEP prescriptions in each state with the number of individuals who would benefit from the HIV-prevention drugs.

They found the greatest jump in PrEP use between 2014 and 2018 was in the early-adopting Northeast, which saw an increase of 16.6%. That was followed by the Midwest (9.2%), the West (7.1%) and, finally, the South (7.0%).

State-level uptake in 2014 ranged from Wyoming’s 0.4% to Massachusetts’ 8.3%, with a median uptake of 1.9%. Uptake in 2018 ranged from Wyoming’s 2.4% to New York’s 29.7%, with a median uptake of 9.6%. Massachusetts, New York and Connecticut were among the top five all years, while Idaho, Montana and Wyoming were among the lowest all years.

Iowa (an outlier among Midwestern states in its early adoption) has offered a telehealth program that could be useful in many rural localities, the researchers say. They also call for states to ensure there are not financial barriers or other obstacles impeding progress. The researchers previously found that Affordable Care Act Qualified Health Plans in the South were almost 16 times more likely to require special authorization for PrEP compared with plans in the Northeast.

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