Patrick S Sullivan, Marta Juhasz, Stephanie N DuBose, Gordon Le, Kamaria Brisco, Duygu Islek, James Curran, Eli Rosenberg
{"title":"2012 - 2022年美国州级PrEP覆盖率与新HIV诊断的关联：PrEP对人口影响的生态学分析","authors":"Patrick S Sullivan, Marta Juhasz, Stephanie N DuBose, Gordon Le, Kamaria Brisco, Duygu Islek, James Curran, Eli Rosenberg","doi":"10.1016/S2352-3018(25)00036-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) medications are highly efficacious for preventing new HIV infections, but the population impact of PrEP depends on whether prescribed PrEP reaches the people at greatest risk in a population, and adherence and persistence on PrEP over time. We sought to use ecological analysis methods to characterise the impact of PrEP on HIV infections at the population level, complementing data from efficacy trials and programmatic monitoring.</p><p><strong>Methods: </strong>We conducted an ecological analysis of US state-level data on PrEP use, HIV viral suppression, and trends in HIV diagnoses in all US states and the District of Columbia by using a nationwide commercial pharmacy database (IQVIA) to calculate PrEP coverage (PrEP users per 100 people with a PrEP indication) and public health surveillance data to document HIV diagnoses from Jan 1, 2012, to Dec 31, 2022, by state and year. States were assigned to quintiles of mean PrEP coverage over the 10-year period, and we calculated quintile-specific changes in HIV diagnoses from 2012 to 2022. We used generalised linear mixed modelling to assess the state-level and national-level associations of PrEP coverage with HIV diagnosis rates, controlling for state-specific viral suppression.</p><p><strong>Findings: </strong>From 2012 to 2022, mean PrEP coverage across the USA increased dramatically from 0·6% to 26·3%, and HIV diagnosis rates decreased modestly from 13·0 to 10·6 per 100 000 population. Proportionate decreases in HIV diagnoses were higher in states with higher PrEP coverage; a significant inverse dose-response relationship existed between PrEP coverage and HIV diagnoses, in that areas with higher PrEP coverage had progressively larger declines in HIV diagnoses.</p><p><strong>Interpretation: </strong>Ecological evidence supports the population-level impact of PrEP in the USA and suggests that higher levels of PrEP coverage are associated with larger reductions in HIV diagnoses, even accounting for effects of viral suppression on HIV transmission. To the extent that these relationships are causal, programmes and policies to lower barriers to PrEP use among people with indications are likely to be associated with subsequent population-level declines in new HIV diagnoses.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"12 6","pages":"e440-e448"},"PeriodicalIF":13.0000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of state-level PrEP coverage and new HIV diagnoses in the USA from 2012 to 2022: an ecological analysis of the population impact of PrEP.\",\"authors\":\"Patrick S Sullivan, Marta Juhasz, Stephanie N DuBose, Gordon Le, Kamaria Brisco, Duygu Islek, James Curran, Eli Rosenberg\",\"doi\":\"10.1016/S2352-3018(25)00036-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) medications are highly efficacious for preventing new HIV infections, but the population impact of PrEP depends on whether prescribed PrEP reaches the people at greatest risk in a population, and adherence and persistence on PrEP over time. We sought to use ecological analysis methods to characterise the impact of PrEP on HIV infections at the population level, complementing data from efficacy trials and programmatic monitoring.</p><p><strong>Methods: </strong>We conducted an ecological analysis of US state-level data on PrEP use, HIV viral suppression, and trends in HIV diagnoses in all US states and the District of Columbia by using a nationwide commercial pharmacy database (IQVIA) to calculate PrEP coverage (PrEP users per 100 people with a PrEP indication) and public health surveillance data to document HIV diagnoses from Jan 1, 2012, to Dec 31, 2022, by state and year. States were assigned to quintiles of mean PrEP coverage over the 10-year period, and we calculated quintile-specific changes in HIV diagnoses from 2012 to 2022. We used generalised linear mixed modelling to assess the state-level and national-level associations of PrEP coverage with HIV diagnosis rates, controlling for state-specific viral suppression.</p><p><strong>Findings: </strong>From 2012 to 2022, mean PrEP coverage across the USA increased dramatically from 0·6% to 26·3%, and HIV diagnosis rates decreased modestly from 13·0 to 10·6 per 100 000 population. Proportionate decreases in HIV diagnoses were higher in states with higher PrEP coverage; a significant inverse dose-response relationship existed between PrEP coverage and HIV diagnoses, in that areas with higher PrEP coverage had progressively larger declines in HIV diagnoses.</p><p><strong>Interpretation: </strong>Ecological evidence supports the population-level impact of PrEP in the USA and suggests that higher levels of PrEP coverage are associated with larger reductions in HIV diagnoses, even accounting for effects of viral suppression on HIV transmission. To the extent that these relationships are causal, programmes and policies to lower barriers to PrEP use among people with indications are likely to be associated with subsequent population-level declines in new HIV diagnoses.</p><p><strong>Funding: </strong>None.</p>\",\"PeriodicalId\":48725,\"journal\":{\"name\":\"Lancet Hiv\",\"volume\":\"12 6\",\"pages\":\"e440-e448\"},\"PeriodicalIF\":13.0000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lancet Hiv\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/S2352-3018(25)00036-0\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Hiv","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/S2352-3018(25)00036-0","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Association of state-level PrEP coverage and new HIV diagnoses in the USA from 2012 to 2022: an ecological analysis of the population impact of PrEP.
Background: Pre-exposure prophylaxis (PrEP) medications are highly efficacious for preventing new HIV infections, but the population impact of PrEP depends on whether prescribed PrEP reaches the people at greatest risk in a population, and adherence and persistence on PrEP over time. We sought to use ecological analysis methods to characterise the impact of PrEP on HIV infections at the population level, complementing data from efficacy trials and programmatic monitoring.
Methods: We conducted an ecological analysis of US state-level data on PrEP use, HIV viral suppression, and trends in HIV diagnoses in all US states and the District of Columbia by using a nationwide commercial pharmacy database (IQVIA) to calculate PrEP coverage (PrEP users per 100 people with a PrEP indication) and public health surveillance data to document HIV diagnoses from Jan 1, 2012, to Dec 31, 2022, by state and year. States were assigned to quintiles of mean PrEP coverage over the 10-year period, and we calculated quintile-specific changes in HIV diagnoses from 2012 to 2022. We used generalised linear mixed modelling to assess the state-level and national-level associations of PrEP coverage with HIV diagnosis rates, controlling for state-specific viral suppression.
Findings: From 2012 to 2022, mean PrEP coverage across the USA increased dramatically from 0·6% to 26·3%, and HIV diagnosis rates decreased modestly from 13·0 to 10·6 per 100 000 population. Proportionate decreases in HIV diagnoses were higher in states with higher PrEP coverage; a significant inverse dose-response relationship existed between PrEP coverage and HIV diagnoses, in that areas with higher PrEP coverage had progressively larger declines in HIV diagnoses.
Interpretation: Ecological evidence supports the population-level impact of PrEP in the USA and suggests that higher levels of PrEP coverage are associated with larger reductions in HIV diagnoses, even accounting for effects of viral suppression on HIV transmission. To the extent that these relationships are causal, programmes and policies to lower barriers to PrEP use among people with indications are likely to be associated with subsequent population-level declines in new HIV diagnoses.
期刊介绍：
The Lancet HIV is an internationally trusted source of clinical, public health, and global health knowledge with an Impact Factor of 16.1. It is dedicated to publishing original research, evidence-based reviews, and insightful features that advocate for change in or illuminates HIV clinical practice. The journal aims to provide a holistic view of the pandemic, covering clinical, epidemiological, and operational disciplines. It publishes content on innovative treatments and the biological research behind them, novel methods of service delivery, and new approaches to confronting HIV/AIDS worldwide. The Lancet HIV publishes various types of content including articles, reviews, comments, correspondences, and viewpoints. It also publishes series that aim to shape and drive positive change in clinical practice and health policy in areas of need in HIV. The journal is indexed by several abstracting and indexing services, including Crossref, Embase, Essential Science Indicators, MEDLINE, PubMed, SCIE and Scopus.
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