HHS Public Access Author manuscript Author Manuscript
Am J Public Health. Author manuscript; available in PMC 2017 May 12. Published in final edited form as: Am J Public Health. 2016 October ; 106(10): e2–e3. doi:10.2105/AJPH.2016.303339.
Disparities in uptake of HIV preexposure prophylaxis in a large integrated healthcare system Julia L. Marcus, PhD, MPH1, Leo B. Hurley, MPH1, C. Bradley Hare, MD2, Michael J. Silverberg, PhD, MPH1, and Jonathan E. Volk, MD, MPH2 1Division
of Research, Kaiser Permanente Northern California, Oakland, CA
Author Manuscript
2Department
of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
To the Editor Although uptake of HIV preexposure prophylaxis (PrEP) is increasing,(1, 2) lower uptake among key HIV risk groups could further increase existing disparities in the HIV epidemic. (3, 4) However, it is unknown whether certain demographic subgroups are underrepresented among PrEP users compared with individuals who recently acquired HIV infection. Thus, we compared demographic characteristics of PrEP users with those of recent HIV seroconverters within the Kaiser Permanente Northern California (KPNC) healthcare system.
Author Manuscript Author Manuscript
KPNC provides comprehensive medical services to 3.9 million members, comprising 46% of insured individuals in the KPNC service area (R. Fong, KPNC Market Strategy and Analysis, written communication, April 2016) and mirroring the demographics of the surrounding population. We included KPNC members who 1) initiated PrEP or 2) acquired HIV infection. PrEP users were those who initiated PrEP after U.S. Food and Drug Administration (FDA) approval (i.e., July 2012–December 2014). Because the demographic composition of those who acquired HIV infection may have changed as high-risk individuals have initiated PrEP, we included HIV seroconverters from the three-year period prior to FDA approval of PrEP (i.e., July 2009–June 2012). Seroconversions were defined as a first lifetime HIV diagnosis at KPNC after a negative HIV test during the three-year pre-PrEP period. Seroconverters were identified using the KPNC HIV registry, and demographic data were collected from the electronic health record. Complete data were not available on transgender identity or HIV-transmission risk factor.
Correspondence should be sent to Julia L. Marcus, Kaiser Permanente Division of Research, 2000 Broad way , 2nd Floor, Oakland , C A 94612 ([email protected]). All other authors report no potential conflicts. Human participant protection: The Kaiser Permanente Northern California institutional review board approved this study with a waiver of written informed consent. Contributor statement: JLM was responsible for the overall conception and design of the study and obtaining funding. LBH was responsible for collecting and assembling the data. JLM was re sponsible for analyzing the data and drafting the letter. All co-authors were responsible for interpretation of the data, critical revision of the letter, and final approval of the letter.
Marcus et al.
Page 2
Author Manuscript
We identified 235 HIV seroconverters and 972 PrEP users (Table 1). Seroconverters were significantly younger than PrEP users (mean age 34.9 vs. 37.9, P
Am J Public Health. Author manuscript; available in PMC 2017 May 12. Published in final edited form as: Am J Public Health. 2016 October ; 106(10): e2–e3. doi:10.2105/AJPH.2016.303339.
Disparities in uptake of HIV preexposure prophylaxis in a large integrated healthcare system Julia L. Marcus, PhD, MPH1, Leo B. Hurley, MPH1, C. Bradley Hare, MD2, Michael J. Silverberg, PhD, MPH1, and Jonathan E. Volk, MD, MPH2 1Division
of Research, Kaiser Permanente Northern California, Oakland, CA
Author Manuscript
2Department
of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
To the Editor Although uptake of HIV preexposure prophylaxis (PrEP) is increasing,(1, 2) lower uptake among key HIV risk groups could further increase existing disparities in the HIV epidemic. (3, 4) However, it is unknown whether certain demographic subgroups are underrepresented among PrEP users compared with individuals who recently acquired HIV infection. Thus, we compared demographic characteristics of PrEP users with those of recent HIV seroconverters within the Kaiser Permanente Northern California (KPNC) healthcare system.
Author Manuscript Author Manuscript
KPNC provides comprehensive medical services to 3.9 million members, comprising 46% of insured individuals in the KPNC service area (R. Fong, KPNC Market Strategy and Analysis, written communication, April 2016) and mirroring the demographics of the surrounding population. We included KPNC members who 1) initiated PrEP or 2) acquired HIV infection. PrEP users were those who initiated PrEP after U.S. Food and Drug Administration (FDA) approval (i.e., July 2012–December 2014). Because the demographic composition of those who acquired HIV infection may have changed as high-risk individuals have initiated PrEP, we included HIV seroconverters from the three-year period prior to FDA approval of PrEP (i.e., July 2009–June 2012). Seroconversions were defined as a first lifetime HIV diagnosis at KPNC after a negative HIV test during the three-year pre-PrEP period. Seroconverters were identified using the KPNC HIV registry, and demographic data were collected from the electronic health record. Complete data were not available on transgender identity or HIV-transmission risk factor.
Correspondence should be sent to Julia L. Marcus, Kaiser Permanente Division of Research, 2000 Broad way , 2nd Floor, Oakland , C A 94612 ([email protected]). All other authors report no potential conflicts. Human participant protection: The Kaiser Permanente Northern California institutional review board approved this study with a waiver of written informed consent. Contributor statement: JLM was responsible for the overall conception and design of the study and obtaining funding. LBH was responsible for collecting and assembling the data. JLM was re sponsible for analyzing the data and drafting the letter. All co-authors were responsible for interpretation of the data, critical revision of the letter, and final approval of the letter.
Marcus et al.
Page 2
Author Manuscript
We identified 235 HIV seroconverters and 972 PrEP users (Table 1). Seroconverters were significantly younger than PrEP users (mean age 34.9 vs. 37.9, P
