HIV Pre-Exposure Prophylaxis (PrEP) Access in Allegheny County, Pennsylvania: 2016-2018

Background & Purpose: In 2016, there were 1103 new HIV diagnoses in Pennsylvania, with Allegheny County accounting for an estimated 11.4% of the new HIV cases. This rate depicts a decrease since 2010. These modest decreases have been attributed to the advances in biomedical HIV prevention. In 2012, the Food and Drug Administration approved pre-exposure prophylaxis (PrEP) to prevent HIV infection for individuals at high-risk for HIV infection. Between 2014 – 2016, the number of PrEP users increased by 470%, however, this number is less than 10% of individuals who have indication for PrEP, currently use PrEP. Notably, PrEP use is lowest among racial/ethnic minorities, who experience disproportionate rates of HIV infection. In response to the National HIV/AIDS Strategy, community partners developed AIDS Free Pittsburgh (AFP). AFP is a coalition comprised of government agencies, healthcare institutions, and community-based organizations that strive to support and improve the care of people living with HIV/AIDS, as well as high-risk negative communities. One of the initiatives of the coalition is to increase PrEP awareness and use in Allegheny County. The goal of the current study is to determine if community efforts resulted in an increased awareness and uptake of PrEP in the county from 2016-2018 and examine the characteristics associated with people who were aware and used PrEP over time.

Methods: The serial, cross-sectional study was conducted from 2016-2018 with a total of 3,343 participants. Participants were recruited from current AFP partner organizations and their networks. Participants completed a survey that was conducted using a paper and electronic version of the instrument and disseminated via face-to-face, e-mail and social media. PrEP awareness and PrEP use were assessed using single-item, categorical questions. Chi square test of independence was used to determine differences in PrEP awareness and use over time. Then logistic regression was used to determine factors predictive of PrEP use.

Results: The Chi square results found statistically significant differences in both PrEP awareness (Χ²(2,3278) = 124.04, p< .001) and PrEP use (Χ²(4,560) = 165.29, p< .001) overall. PrEP awareness among participants grew from 27.1% in 2016 to 43.1% in 2018. Similarly, PrEP use among participants grew from 10% in 2016 to 54.8% in 2018. The logistic regression model found individuals with insurance (1.94), White individuals (1.94), individuals with high-risk (6.04), and older individuals (1.35) were more likely to report PrEP awareness. In the model predicting PrEP use, individuals with insurance (2.00), males (5.05), individuals at high-risk (5.48) and older individuals (2.01) were more likely to report current PrEP use.

Discussion:The findings suggest initiatives under AFP overall have increased the awareness and use of PrEP in Allegheny County. The dramatic increases are an important step in reducing HIV infections in the county, however uptake is still below suggested PrEP coverage in models for reducing overall HIV incidence. Furthermore, differences in use among heterosexuals, racial minorities, and younger adults, suggest the need for further interventions to increase use among high-risk groups.