EditorialProgress and pitfalls in measuring HIV preexposure prophylaxis coverage in the United States
Section snippets
Numerators for PrEP coverage: measures of PrEP use and access
The numerators for metrics of PrEP coverage, including the PrEP prevalence and PrEP-to-need ratio estimates in Sullivan et al. and Siegler et al., are estimates of PrEP use derived from a national prescription database obtained from Source Healthcare Analytics, LLC by Gilead Sciences, Inc., and recently made public through AIDSVu.org. Drug exposure periods were identified for each individual, and the authors state that prescription data were linked to a healthcare claims database to identify
Denominators for PrEP coverage: measures of PrEP need
Critical to setting priorities and benchmarking progress for PrEP coverage is the availability of “denominators” that reflect PrEP need in populations. Compared with the use of antiretroviral therapy for HIV treatment, for which the target population is easily defined and static over time within persons, HIV risk and the related construct of PrEP indication are fluid, time-dependent processes that are complex functions of both behaviors and epidemic characteristics [30], [31]. We see multiple
Translation to policy
How can we translate these epidemiologic measures to PrEP-related policies, most rudimentarily, “how much PrEP do we need for a given community?” Principles of the number needed to treat dictate that more PrEP coverage will be required to avert HIV infections in low-incidence groups compared with high-incidence ones, an important consideration when comparing PrEP need between heterosexuals and MSM, or females and males [10], [35]. Lack of efficiency demands that we try harder as a public health
Paths forward
Taken together, these four studies highlight paths forward for future research, with the goal of rigorously measuring the success of PrEP scale up in at-risk populations. First, work is needed to further refine the metrics developed in these studies, and to understand to what extent they are valid measures of PrEP coverage, access, and need in a population. Second, work is needed to understand whether these metrics can be used for comparisons between populations, or over time within a
Acknowledgments
This work was supported in part by the National Institute of Allergy and Infectious Diseases (K01 AI122853 to J.L.M.), CDC National Center for HIV, Viral Hepatitis, STDs, and TB Prevention Epidemic and Economic Modeling Agreement (NEEMA) (U38 PS004646-01 to E.S.R.), and National Institute on Drug Abuse (R01 DA038196 to E.S.R.).
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