1963. PrEP Significantly Reduces the Rate of New HIV Diagnoses in US Metropolitan Statistical Areas Independent of Treatment as Prevention (2012–2017)

Abstract

BackgroundTenofovir/Emtricitabine (TVD) was approved for a Pre-exposure Prophylaxis (PrEP) indication in the United States in July 2012. Biomedical HIV prevention tools can impact the rate of new HIV diagnoses but their relative contributions have not been described.MethodsThe analysis utilized CDC published data on HIV diagnoses in 105 US metropolitan statistical areas (MSAs), a Treatment as Prevention (TasP) proxy of HIV suppressed individuals from 38 US states and DC, and a national pharmacy and medical claims databases to track TVD PrEP use from 2012 to 2017. The calculation of person time at risk excluded time of those taking PrEP as well as those who became HIV positive. TVD PrEP use was categorized in quintiles. A multilevel Poisson regression model which considers changes over time of each MSA was utilized. Rates and rate ratios plus corresponding 95% confidence intervals were obtained for quintiles of PrEP utilization after adjusting for the effect of treatment as prevention and calendar time.ResultsThe US MSA rate of HIV diagnoses decreased significantly at a rate of 5.1% (95% CI −4.8 to −5.3%) per year in the period 2012–2017. PrEP use increased from an average of 1.64+1.3 per 100 subjects with a PrEP indication in 2012 to 15.4 + 3.2 in 2017. HIV viral suppression also increased by 1.3% per year (95% CI 1.1 to 1.6%) during the same period among HIV treated subjects. A multivariate model showed that PrEP use was significantly associated with the decline in the rate of new HIV cases, independent of a significant TasP effect. During the period of observation, the lowest quintile of PrEP utilization saw a decline of −0.23% (95% CI −0.2 to −0.43%), while the highest quintile of PrEP utilization showed a statistically significant decline of −4.24% (95% CI −0.39 to −8.01%) per year. Treatment as prevention had a significant and independent effect of- 1.56% (−1.1 to −2.1%) per each percent increase of the proportion of HIV subjects with suppression.ConclusionFrom 2012 to 2017, HIV diagnoses declined most steeply in MSAs where PrEP use was the highest. The effect of PrEP use was significantly associated with this decline and was independent of treatment as prevention. Disclosures All Authors: No reported Disclosures.