Utilization of oral pre-exposure prophylaxis (PrEP) after FTC/TAF approval in the United States'

Title

Utilization of oral pre-exposure prophylaxis (PrEP) after FTC/TAF approval in the United States'

Presenter

Richard Elion

Authors

R. Elion * (1), J. Gruber (2), J. Radtchenko (3), M. Dunbar (2), K. Mayer (4), G. Huhn (5), K. Mounzer (6)

Institutions

(1) George Washington University School of Medicine, Washington, DC, United States, (2) Gilead Sciences, Foster City, United States, (3) Trio Health, Louisville, United States, (4) Fenway Health, The Fenway Institute, Boston, United States, (5) The Ruth M. Rothstein Core Center, Rush University Medical Center, Chicago, United States, (6) School of Medicine at the University of Pennsylvania, Philadelphia Fight Community Health Centers, Philadelphia, United States

BACKGROUND: Two oral medications are approved for PrEP in the US: emtricitabine/tenofovir disoproxil fumarate and tenofovir alafenamide (FTC/TDF, FTC/TAF). This study describes socio-demographic and clinical characteristics of individuals new to PrEP after the approval of FTC/TAF in the US (October 2019) to better understand PrEP prescription and dispense patterns in clinical practice.
METHODS: EMR and dispensing data from Trio Health HIV Research Network (10/2019-11/2021) were used for the study. Included: HIV-negative adults prescribed or dispensed oral PrEP ('¥1-month supply) with '¥3 months follow-up. Excluded: indications of HBV or PEP. Comorbidities, socio-demographic and clinical characteristics for PrEP-naïve participants were compared among those prescribed and (separately) those dispensed FTC/TAF vs FTC/TDF (t-test, chi-square) at the same facilities.
RESULTS: In the prescription cohort (N=2213), most individuals were prescribed FTC/TAF (1821 [82%] vs. FTC/TDF 392 [18%]). A similar distribution was observed for the dispense cohort (N=1794; FTC/TAF 1551 [86%]; FTC/TDF 243 [14%]).In both cohorts, most participants had commercial insurance and FTC/TAF individuals were more likely to be white and male. In the prescription cohort, high-risk behavior and clinical characteristics, including BMI and renal function (eGFR mL/min/1.73m²), were similar for FTC/TAF and FTC/TDF among those with available data [Table]. Individuals dispensed FTC/TAF were more likely to be overweight at baseline (39% vs. 29%; p=.019), with high-risk behavior (75% vs. 63%, p<.001), age >50 (16% vs. 11%, p=.041), and less likely to be age '¤25 (13% vs 18%, p=.018).

CONCLUSIONS: This retrospective observational study among adults initiating PrEP after FTC/TAF approval showed most new PrEP users were prescribed and dispensed FTC/TAF. While differences were observed in socio-demographic characteristics between regimens and across cohorts, evidence suggests that individual safety risk factors (e.g., age and renal function) may not factor into prescribing decisions.

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