For New York State to reach its goal of bringing down the number of annual new HIV infections to the EtE Initiative’s goal of 750 by 2020, Pre-exposure Prophylaxis (PrEP) will play a critical role.
Population-based data on PrEP usage and availability does not exist for New York State yet. However, there are a number of efforts aimed at monitoring PrEP uptake.
A recent analysis conducted by a team at the New York City Department of Health and Mental Hygiene (NYC DOHMH) used data from the Primary Care Information Project’s Hub Population Health System (‘Hub’) to examine PrEP prescriptions among NYC ambulatory care practices 2012-2014. The ‘Hub’ connects to over 700 medical practices and includes data from approximately 17% of NYC adults with primary care visits.
Study findings showed a substantial increase in PrEP prescription rates from 2012 to 2014 among 542 NYC ambulatory care practices. The largest increase was observed in the second half of 2014 (see Figure 1). In the last quarter of data (Q4 2014), PrEP prescription rates were highest in hospital outpatient settings but also occurred in community health centers and independent practices.
The largest increase in PrEP prescription rates over time was found among practices located in the Chelsea-Village neighborhood; a primarily affluent neighborhood where many men who have sex with men (MSM) live and access clinical care (Figure 1). At the end of 2014, the highest PrEP prescription rates were among Manhattan practices (Figure 2). Although increases were seen in other neighborhoods, the NYC DOHMH team noted that differences by practice neighborhood may highlight disparities in access to PrEP.
Limitations of the analysis include those associated with the use of electronic health records to identify unique PrEP prescriptions, and that medical practices included in this study may not be representative of all medical practices in NYC.
Source: Edelstein ZR, Newton-Dame R, Myers JE, Salcuni PM, and Jacobson L. Pre-exposure Prophylaxis (PrEP) in Ambulatory Care Practices, New York City, 2012-2014. 2015 IAPAC Conference (Abstract number 126).
HIV Post-Exposure Prophylaxis (PEP) is a 28-day regimen of anti-HIV medications that may prevent HIV transmission if started within 36 hours of an exposure to HIV. As with PrEP, population-based data on PEP usage and availability do not exist for New York State yet.
Another NYC DOHMH study examined trends in PEP-related emergency department (ED) visits in New York City from 2002-2013, using NYC syndromic surveillance data. Some highlights from the study findings include:
- PEP-related visits in NYC EDs appeared to increase over the past decade
- Associations with male sex and younger age grew stronger over time, possibly indicating changes in PEP prescribing patterns (Figure 1 below)
- Lower proportions of PEP-related visits among patients residing in high poverty neighborhoods may highlight disparities in access
Limitations of the analysis include that PEP-related visits were identified based on chief complaint and thus may not completely measure whether PEP was prescribed or used. Additionally, trends and associations may not be generalizable to other clinical environments in NYC, or to practices outside of NYC.
Source: Edelstein ZR, Ngai S, Weiss D, Salcuni PM, Myers JE. Post-Exposure Prophylaxis (PEP) in New York City Emergency Departments, 2002-2013. 2015 IAPAC Conference (Abstract number 110).
We are grateful to our colleagues at NYC DOHMH for this important work.
Until there are established PrEP and PEP metrics to be included and reflected routinely on the ETE Dashboard, we will post relevant data on PrEP and PEP uptake as they become available.
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