Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015

Ann Epidemiol. 2018 Dec;28(12):850-857.e9. doi: 10.1016/j.annepidem.2018.05.003. Epub 2018 May 18.

Abstract

Purpose: Effectively measuring progress in delivering HIV pre-exposure prophylaxis (PrEP) requires subnational estimates of the number of adults with indications for its use that account for differences in HIV infection rates by transmission risk (risk) group and race/ethnicity.

Methods: We applied a multiplier method with 2015 Centers for Disease Control and Prevention surveillance data on proportions of HIV diagnoses by race/ethnicity and risk group and population-based estimates of risk group sizes to derive estimated numbers of adults with indications by risk group (men who have sex with men [MSM], heterosexually active adults [HET], and persons who inject drugs [PWID]) by race/ethnicity in each jurisdiction.

Results: An estimated 1.1 million adults had indications for PrEP use in 2015: 813,970 MSM, 258,080 HET, and 72,510 persons who inject drugs, and 500,340 blacks, 282,260 Latinos, and 303,230 whites. Among HET, 176,670 females and 81,410 males had indications. The proportions of adults with indications in each risk and race/ethnicity group varied by jurisdiction.

Conclusions: Blacks comprised the highest number of adults with indications showing that increasing PrEP use in this population must be the highest priority. MSM remain a priority because of the high number with indications. These estimates can be used as denominators to assess PrEP coverage and impact on HIV incidence at subnational levels.

Keywords: HIV; Heterosexuals; MSM; PWID; PrEP; Racial/ethnic populations.

MeSH terms

  • Adolescent
  • Adult
  • African Americans / psychology
  • African Americans / statistics & numerical data
  • Anti-HIV Agents / therapeutic use
  • Ethnic Groups / statistics & numerical data*
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • Heterosexuality
  • Hispanic Americans / psychology
  • Hispanic Americans / statistics & numerical data
  • Homosexuality, Male
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Population Surveillance / methods*
  • Pre-Exposure Prophylaxis / methods*
  • Pre-Exposure Prophylaxis / statistics & numerical data
  • Risk Factors
  • Safe Sex
  • Sexual and Gender Minorities / statistics & numerical data*
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / psychology
  • United States / epidemiology
  • Young Adult

Substances

  • Anti-HIV Agents