Will Garner1, Brigid M Wilson1, Lauren Beste1, Marissa Maier1, Michael E Ohl1, Puja Van Epps1. 1. Will Garner is with University Hospitals Cleveland Medical Center, Cleveland, OH. Brigid M. Wilson is with Geriatric Research Education and Clinical Center, Research Service, Louis Stokes Cleveland VA Medical Center, and Case Western School of Medicine, Department of Medicine, Division of Infectious Diseases and HIV Medicine, Cleveland. Marissa Maier is with VA Portland Health Care System, and Department of Internal Medicine, Division of Infectious Diseases, Oregon Health and Sciences University, Portland. Lauren Beste is with VA Puget Sound Health Care System, and University of Washington School of Medicine, Department of Medicine, Division of General Internal Medicine, Seattle. Michael E. Ohl is with VHA Office of Rural Health Resource Center, and Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City. Puja Van Epps is with Geriatric Research Education and Clinical Center, Department of Medicine, Louis Stokes Cleveland VA Medical Center, and Case Western School of Medicine, Department of Medicine, Division of Infectious Diseases and HIV Medicine.
Abstract
OBJECTIVES: To report demographics, regional variations, and indications for preexposure prophylaxis (PrEP) use for HIV prevention in the Veterans Health Administration (VHA). METHODS: We identified persons initiating tenofovir/emtricitabine for the PrEP indication in the United States between July 2012 and April 2016 in a VHA national database. We stratified PrEP use by provider type and VHA region. We calculated PrEP initiation rate for each region with VHA population data. RESULTS: Of the 825 persons who initiated PrEP during the observation period, 67% were White and 76% were men who have sex with men. People who inject drugs and transgender persons represented less than 1% each of the cohort. The majority of PrEP initiations were clustered in 3 states, leading with California (28%) followed by Florida (9%) and Texas (8%). The Southeast had one of the lowest PrEP rates at 10 PrEP initiations per 100 000 persons in care. Infectious disease specialists issued more than two thirds of index PrEP prescriptions. CONCLUSIONS: Uptake of PrEP in the VHA is uneven along geographic and risk categories. Understanding the reasons behind these gaps will be key in expanding the use of this important prevention tool.
OBJECTIVES: To report demographics, regional variations, and indications for preexposure prophylaxis (PrEP) use for HIV prevention in the Veterans Health Administration (VHA). METHODS: We identified persons initiating tenofovir/emtricitabine for the PrEP indication in the United States between July 2012 and April 2016 in a VHA national database. We stratified PrEP use by provider type and VHA region. We calculated PrEP initiation rate for each region with VHA population data. RESULTS: Of the 825 persons who initiated PrEP during the observation period, 67% were White and 76% were men who have sex with men. People who inject drugs and transgender persons represented less than 1% each of the cohort. The majority of PrEP initiations were clustered in 3 states, leading with California (28%) followed by Florida (9%) and Texas (8%). The Southeast had one of the lowest PrEP rates at 10 PrEP initiations per 100 000 persons in care. Infectious disease specialists issued more than two thirds of index PrEP prescriptions. CONCLUSIONS: Uptake of PrEP in the VHA is uneven along geographic and risk categories. Understanding the reasons behind these gaps will be key in expanding the use of this important prevention tool.
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