HIV pre-exposure prophylaxis among people initiating buprenorphine for opioid use disorder in the ambulatory setting: A retrospective cohort study.

Abstract

Buprenorphine (BUP) is an effective treatment for opioid use disorder (OUD) that may create opportunities to expand access to preventive services for patients with OUD. HIV prevention, particularly pre-exposure prophylaxis (PrEP), represents a vital service for persons with OUD due to HIV risk associated with injection drug use and condomless sex. Evaluating the integration of BUP treatment and HIV prevention is an important step to further optimize care for patients with OUD. This retrospective cohort study used pharmacy claims from the Merative™ MarketScan® Research Databases, 2014-2022, to examine use of PrEP among new BUP treatment episodes over the first nine weeks of treatment. We excluded BUP episodes from individuals with probable HIV based on diagnosis or medications indicated for HIV in the past 365 days. Clinical indications for PrEP were identified based on past 365-day diagnosis of sexually transmitted infections or serious injection-related infections. Of 119,863 BUP episodes representing 76,377 individuals, 102 (0.1%) involved PrEP during BUP treatment. Most of these episodes (71%) involved PrEP in the 30 days prior to BUP initiation. Only 6% of the sample exhibited diagnoses indicating risk for HIV. Of these, only 0.2% involved PrEP during the BUP episode. Findings from this retrospective cohort study identify a major gap in PrEP use for individuals with OUD and documented HIV risk. Aligning HIV prevention and BUP treatment is an important opportunity to enhance health for patients with OUD.