Trends in HIV Preexposure Prophylaxis Use Before and After Launch of the Ending the HIV Epidemic in the US Initiative, 2016-2023

Abstract

Introduction: The Ending the HIV Epidemic (EHE) in the US initiative was launched by the US Department of Health and Human Services in 2019 with the goal of decreasing new HIV infections 90% by 2030. Increasing the use of HIV preexposure prophylaxis (PrEP) is one of the EHE strategies. We assessed the impact of EHE activities on PrEP use.

Methods: Using IQVIA real-world longitudinal prescription data and the National HIV Surveillance System data, we calculated jurisdiction-level PrEP to diagnosis ratios (PDRs) in the United States from 2016 to 2023. We assessed impact of EHE with a difference-in-difference analysis.

Results: The PDR increased from 3.0 to 14.7 in EHE jurisdictions, from 1.2 to 7.2 in EHE states, and from 2.5 to 13.4 in non-EHE jurisdictions. On average, no additional increase in the PDR was found for EHE counties compared with matched non-EHE counties, (adjusted difference-in-difference: 0.2, 95% confidence interval: -1.0 to 1.3), or for EHE states (adjusted difference-in-difference: 0.4, 95% CI: -1.6 to 2.4).

Conclusions: Overall PrEP use increased markedly, with some EHE jurisdictions achieving greater increases than non-EHE jurisdictions with similar PDRs in 2019. The uneven increase in PrEP use in EHE jurisdictions underscores the need for jurisdiction-specific PrEP implementation strategies designed for the needs of each community. It also underscores the need for sufficient funding to accomplish EHE goals.

Keywords: HIV; PrEP; ending the HIV Epidemic initiative (EHE).