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

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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.