UC San Diego

BackgroundHIV pre-exposure prophylaxis (PrEP) is a key to the United States’ (US) Ending the HIV Epidemic plan. This research aims to 1) evaluate PrEP utilization in jurisdictions with the highest HIV new diagnosis incidence, 2) determine PrEP correlation with new HIV diagnoses, income, geopolitical, race and/or geo-spatial factors.

MethodsAnalysis of 2012-2019 PrEP data implementing linear mixed methods statistical modeling. The dependent variable was county PrEP rate. Fixed effects were HIV diagnoses, state income, percentage of black, indigenous and people of color (BIPOC) in state populations and governor political affiliation. Random effects were regions and counties of the US. Only the 50 US jurisdictions with the highest new HIV diagnosis rates were analyzed.

Results For each 10,000 U.S. dollar increase in mean income, there was a significant increase in PrEP utilization by 66.4/100,000 persons (95%CI 58.6-74.3, p<0.001). Jurisdictions with higher HIV diagnosis rates have reduced PrEP utilization -2.73/100,000 for each new 1 diagnosis per 100,000 in the population (95%CI -3.71 – -1.80,p <0.001). For each increase of BIPOC by 1 percentile point, PrEP utilization decreased by a rate of -522.34 per 100,000 prescriptions (95%CI -958.4 – -134.8,p <0.05).

ConclusionFindings suggest lower income, higher rates of HIV diagnoses, and higher proportion of BIPOC persons correlate to lower rates of PrEP use. Regional location and political party of state governors was not associated with PrEP uptake.