Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

Am J Epidemiol. 2019 Apr 1;188(4):743-752. doi: 10.1093/aje/kwy230.

Abstract

The potential for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States might be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (BMSM and WMSM) in the Atlanta, Georgia, area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could affect HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (hazard ratio = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (hazard ratio = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.

Keywords: human immunodeficiency virus; mathematical model; men who have sex with men; preexposure prophylaxis; racial disparities.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Anti-HIV Agents / therapeutic use*
  • European Continental Ancestry Group / statistics & numerical data*
  • Georgia / epidemiology
  • HIV Infections / epidemiology*
  • HIV Infections / ethnology
  • HIV Infections / prevention & control
  • Health Status Disparities
  • Homosexuality, Male / ethnology
  • Homosexuality, Male / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Network Meta-Analysis
  • Pre-Exposure Prophylaxis / statistics & numerical data*
  • Sexual and Gender Minorities / statistics & numerical data
  • United States
  • Young Adult

Substances

  • Anti-HIV Agents