National Trends in HIV Pre-Exposure Prophylaxis Dispensing to Young Adults, 2016-2023.

Abstract

U.S. young adults account for a disproportionate share of new HIV diagnoses. Despite this, no national study has examined recent trends in HIV pre-exposure prophylaxis (PrEP) dispensing to this age group. To assess trends in PrEP dispensing to young adults from 2016 to 2023. Cross sectional study of the IQVIA Longitudinal Prescription Database. Young adults aged 18-25 years. Quarterly PrEP dispensing rate (number of young adults with dispensed PrEP prescriptions per 100,000 U.S. young adults), quarterly PrEP initiation rate (number of young adults with a new dispensed PrEP prescription per 100,000 U.S. young adults), and quarterly mean PrEP persistence (number of days with an active PrEP prescription in the 180 days after the new PrEP prescription ended among those initiating therapy). Joinpoint regression was used to identify slope changes and calculate the quarterly percent change (QPC). Subgroup analyses were conducted by age group. Analyses included 1,450,296 PrEP prescriptions dispensed between January 1, 2016-December 31, 2023 to 239,780 young adults. The quarterly PrEP dispensing rate increased sharply between 2016-2018, from 26.4 to 100.7 prescriptions per 100,000 people (QPC: 12.5%, 95% CI: 10.0 to 15.1). Afterwards, this rate increased gradually to 208.4 prescriptions per 100,000 people in 2023 (QPC: 3.5%, 95% CI: 2.7 to 4.3). Trends in the quarterly PrEP initiation rate were qualitatively similar. From 2016 to 2023, quarterly mean persistence decreased from 111.6 to 98.4 days (QPC: -0.4%, 95% CI: -0.6, -0.2). Compared with patients aged 22-25 years, those aged 18-21 years had lower quarterly PrEP dispensing and initiation rates throughout 2016-2023. Persistence was lower in these younger patients in 2016, but the gap narrowed over time. Dispensing and initiation of PrEP among young adults is increasing, but treatment episodes are shortening. Efforts to promote retention in therapy are needed.