Photo Credit: Bowonpat Sakaew

Despite an improved HIV PrEP-to-need ratio from 2018 to 2021, PrEP use relative to need was lower in certain populations, including women and younger people.

Despite the observation of an improved HIV PrEP-to-need (PnR) ratio between 2018 and 2021 overall, levels of PrEP use relative to need were lower in certain populations, including women and younger people.

Researchers reported their findings in the Canada Communicable Disease Report.

“HIV-PrEP use is much higher among males, likely, in part, due to the high uptake of HIV-PrEP among gbMSM [gay, bisexual, and other men who have sex with men],” Joseph Cox, MD, and colleagues wrote.

The study estimated the prevalence of PrEP use and PnR by sex, age, and province for 2018 through 2021 to identify groups with higher needs for PrEP. Researchers used healthcare data from IQVIA and the BC Centre for Excellence in HIV/AIDS on annual estimates for PrEP use and data from the National HIV Surveillance System on new HIV diagnoses for their PnR analyses.

PnR is a metric “defined as the ratio of HIV PrEP users per new HIV diagnoses,” the authors wrote. “A higher level of PnR indicates more HIV PrEP users relative to estimated need.”

Disparities by Sex & Age Observed

In 2018, an estimated 13,222 people received PrEP prescriptions. By 2021, the estimate grew to 23,644 people, representing a PrEP prevalence of 66.9 per 100,000 people, according to the study. The findings reflect a 1.8-fold increase in PrEP users over the 4 years of the study.

“The PnR was 16.8 in 2021, meaning that for every person newly diagnosed with HIV, 17 HIV-negative individuals were using HIV PrEP,” researchers wrote. “From 2018 to 2021, annual HIV PrEP use prevalence increased while reported HIV incidence declined, leading to a 2.3-times increase in PnR.”

Analyses also identified disparities between provinces, sexes, and age groups. Specifically, women and people aged 19 and younger had lower levels of PrEP use relative to epidemic need, the study found.

According to Dr. Cox and colleagues, varying regional policies may affect PrEP updates and contribute to disparities.

“In addition,” the researchers wrote, “challenges encountered by clinicians in identifying women who have HIV PrEP indications may contribute to lower uptake among females.”