Dr Bob Grant, Principal Investigator of the iPrEx study, told meeting attendees that a survey of US pharmacies that dispense PrEP found 8512 individuals who had had Truvada (tenofovir/emtricitabine) prescribed to them as PrEP from the beginning of 2012. The last time aidsmap.com reported on this study a year ago, the figure was 3253, so prescriptions have more than doubled in a year.
The true number of people on PrEP, however, is considerably higher. The proportion of US pharmacies participating in the PrEP survey has also declined during the year, from 55% to 39%, so the increase has probably been even greater and could be nearly 22,000, if non-reporting pharmacies prescribed PrEP at the same rate as reporting ones.
In addition to pharmacy-prescribed PrEP, an estimated 8,000 people are receiving PrEP in demonstration studies, through the US Medicaid system, or via the patient assistance programme operated by Truvada manufacturers Gilead. This adds up to nearly 30,000 people.
The true figure is likely to be somewhat lower, as non-reporting pharmacies may be prescribing less PrEP and also because some may have already stopped PrEP. Dr Ken Mayer, principal investigator ofthe ADAPT study, said that at his own clinic, the Fenway Center in Boston, 14.5% of those who had started PrEP had already stopped (another 30% stopped PrEP but subsequently restarted). However the total of PrEP users in the US is now unlikely to be below 25,000.
The Fenway’s PrEP project started in 2012, but 80% of its 663 participants started last year, reflecting a general recent expansion in PrEP use. This experience is echoed by that of other clinics. For instance, in New York’s large Callen/Lorde Community Health Center, although PrEP has been on offer since March 2012, only 30 people had come forward for it up to January 2014. At this point demand started to increase and is still increasing: the cumulative number of PrEP prescriptions is now 982.
Dr Mayer said that this figure only represented one-twentieth of the people in the US who might benefit from PrEP. It is estimated that there are approximately 275,000 gay men and 140,000 heterosexuals in the US – 415,000 in total – who are at the kind of risk of HIV that would justify taking PrEP.
Bob Grant added that it still seemed to be the case that those who were at the highest risk were the most likely to ask for PrEP: three separate surveys in San Francisco have found that 4 to 10% of gay men with one sexual partner in the last year were now taking, or had ever taken, PrEP, 11 to 17% of those with two partners, and 25 to 33% of those with three or more. “PrEP is essentially a demand-driven measure,” he added.
Mayer said that PrEP prescribing was still skewed to those who could afford it with over 80% having it paid through private insurance and 80% of recipients being white gay men. The two biggest barriers to PrEP use were still lack of demand and lack of insurance coverage: however a survey of healthcare practitioners found that the third most common reason was that practitioners felt untrained to prescribe PrEP.