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  Conference on Retroviruses
and Opportunistic Infections
Seattle, Washington
March 4-7, 2019
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Estimate of US MSM eligible for PrEP
jumps from 25% in 2015 to 45% today
  Conference on Retroviruses and Opportunistic Infections (CROI), March 4-7, 2019, Seattle
Mark Mascolini
Among sexually active US men who have sex with men (MSM), the proportion meeting guideline eligibility for preexposure prophylaxis (PrEP) jumped from 24.7% in a 2015 analysis to 45% today [1]. Emory University researchers who conducted the new study found this higher PrEP eligibility rate held constant regardless of race/ethnicity or geographic region.
Using 2014 US Public Health Service (USPHS) guidelines, the CDC estimated in 2015 that 24.7% of sexually active US MSM were eligible for PrEP [2]. In 2017 the USPHS updated its PrEP guidelines, listing five eligibility criteria for MSM: (1) age 18 or older, (2) HIV-negative, (3) sex within 6 months, (4) active in a sexual network (not a monogamous relationship with an HIV-negative partner), and (5) recent behavioral risk, such as condomless anal sex or a bacterial sexually transmitted infection (STI) in the past 6 months [3].
To provide an updated estimate of PrEP eligibility among sexually active MSM, the Emory investigators recruited US internet-using MSM who completed the American Men's Internet Survey. Participants in this analysis had to be male-born and identifying, ever sexually active with another man, and age 15 to 65. The formula to estimate PrEP eligibility had USPHS 2017 PrEP indications as the numerator and sexually active HIV-negative men as the denominator.
Among the 4196 sexually active HIV-negative MSM assessed, 45% met USPHS base indications for PrEP (18 or older, HIV-negative, sexually active with a man in the past 6 months). Almost one third (32%) met base indications plus condomless anal sex or an STI within 6 months. The 45% base indication estimate did not differ much by race or geographic region (Northeast, Midwest, South, West). Nor did the base plus recent anal sex or STI estimate.
A lower proportion of the youngest age group (15-17) than older age groups met the three USPHS base indications: 27.6%. PrEP eligibility by those criteria rose with older age through age 54: 18-24, 36.6%; 25-34, 42.1%; 35-44, 49.9%; 45-54, 57.5%; 55-65, 51.5%. Across those six age groups, PrEP eligibility rose when figured as base criteria plus recent anal sex or STI: 13.5%, 26.0%, 31.3%, 36.5%, 42.1%, 33.6%.
The Emory team concluded that more sexually active US MSM than previously estimated are probably eligible for PrEP. Because of rising HIV case counts among younger and minority MSM, they added, "additional age- and race/ethnicity-based considerations for [PrEP] uptake may be needed to improve PrEP access."
1. Weiss KM, Prasad P, Ramaraju R, Anderson EJ, Jenness S. Estimated PrEP eligibility in a national sexual network study of MSM. Conference on Retroviruses and Opportunistic Infections (CROI). March 4-7, 2019. Seattle. Abstract 971.
2. Smith DK, Van Handel M, Wolitski R, et al. Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition--United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(46).
3. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States--2017 update. 2018. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf