Uptake of HIV Preexposure Prophylaxis Among Commercially Insured Persons—United States, 2010–2014

Abstract

Background: Daily, oral use of tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) for preexposure prophylaxis (PrEP) is an effective strategy to prevent acquisition of HIV infection. It is important to monitor PrEP uptake at the national level to increase our understanding of trends in its utilization, but national HIV surveillance data do not include PrEP uptake. Our objective was to develop feasible methods to estimate PrEP uptake, and to estimate uptake each year among commercially insured persons during 2010-2014. Methods: We conducted a retrospective analysis of the 2010–2014 MarketScan database, a national sample of persons with commercial health insurance in the United States. We developed an algorithm to identify persons aged ≥16 years who were prescribed TDF-FTC for PrEP each year. We generated nationally representative estimates of prevalence of persons prescribed PrEP. Results: We found a significantly increasing trend in the proportion of persons prescribed TDF-FTC for PrEP over the study period, with 417 users in 2010 and 9,375 users in 2014 (P < 0.001). In 2014, among PrEP users 97% were male and 98% resided in metropolitan areas. Over the time period studied, the numbers of women prescribed PrEP were low. Conclusions: Our analytic methodology provides the only feasible means to monitor PrEP uptake in the United States. While a marked increasing trend in uptake was observed for males, the number of females who used PrEP remained very low during the study period. Interventions are needed to increase PrEP use by women at substantial risk of acquiring HIV infection.