Abstract
BackgroundOral pre-exposure prophylaxis (PrEP) is a highly effective option for HIV prevention. To realize the full benefit of PrEP at the population level, uptake must reach those at the greatest risk of HIV acquisition. Guidance published by Centers for Disease Control and Prevention (CDC) suggests that the number of individuals with indications for PrEP is 1.1-1.2 million nationally based on survey data of key populations and local transmission patterns. We applied these estimates at state and county levels to determine the number of individuals who might benefit from PrEP locally and compared our estimates to CDC-published estimates for Colorado.ObjectiveThis analysis aimed to produce estimates of key populations with indications for PrEP in Colorado as a whole and by county type. These estimates will be used for public health strategic planning for HIV prevention goals at the state and county jurisdictional levels.MethodsColorado population estimates were obtained from the state demography office, which utilizes US decennial census data and input from county and local agencies to forecast the population. We limited our analysis to adults aged 18-59 years to be consistent with CDC methodology for PrEP estimates. We performed a literature review to define the best population-level percentages to determine numbers of HIV-negative men who have sex with men (MSM) and people who inject drugs (PWID) in Colorado. These percentages were applied to the state and to each county by its rural-urban designation. Finally, CDC-derived percentages of MSM and PWID with indications for PrEP were applied to these estimates to determine numbers of MSM and PWID who may benefit from PrEP use.ResultsIn 2017, 3,252,648 adults aged 18-59 years were living in Colorado. By applying published estimates of percentages of men who had sex with other men in the past 12 months, we determined that 41,353-49,624 adult males could be considered sexually active MSM. We estimated that 9758-13,011 adults aged 18-59 years were likely to have injected drugs in the past 12 months. By accounting for numbers of people living with HIV in those categories and applying the CDC PrEP percentages of MSM and PWID with indications for PrEP nationally, we estimated that 8792-12,528 MSM and PWID in Colorado had indications for PrEP; this number is smaller than that estimated by CDC, although within the lower CI limit.ConclusionsBy employing a simple framework consisting of census data, literature review, population estimates, and national estimates for PrEP indicators, we derived estimates for potential PrEP use in our state. Statewide estimates of key populations by state and county type will enable health officials to set informed goals and track progress toward optimizing PrEP uptake. This formula may be applicable to other states with similar epidemics and resources.
Highlights
Like many states, Colorado observed a decline in HIV diagnosis rates between 2005 and 2015, leading regional stakeholders to consider the possibility of ending the HIV epidemic in the state [1]
Centers for Disease Control and Prevention (CDC)-derived percentages of men who had sex with men (MSM) and people who injected drugs (PWID) with indications for pre-exposure prophylaxis (PrEP) were applied to these estimates to determine numbers of MSM and PWID who may benefit from PrEP use
By accounting for numbers of people living with HIV in those categories and applying the CDC PrEP percentages of MSM and PWID with indications for PrEP nationally, we estimated that 8792-12,528 MSM and PWID in Colorado had indications for PrEP; this number is smaller than that estimated by CDC, within the lower CI limit
Summary
Colorado observed a decline in HIV diagnosis rates between 2005 and 2015, leading regional stakeholders to consider the possibility of ending the HIV epidemic in the state [1]. In their paper in the Morbidity and Mortality Weekly Report, Smith et al analyzed survey data from the National Health and Nutrition Examination Survey, National Survey on Drug Use and Health, and National HIV Behavioral Surveillance System and concluded that nationally, approximately 1.2 million individuals in the United States had the Centers for Disease Control and Prevention (CDC)-recommended indications for PrEP [6] They determined that 24.7% of men who had sex with men (MSM) in the past 12 months, 18.5% of people who injected drugs (PWID) in the past 12 months, and 0.4% of sexually active heterosexual adults had indications for PrEP. Guidance published by Centers for Disease Control and Prevention (CDC) suggests that the number of individuals with indications for PrEP is 1.1-1.2 million nationally based on survey data of key populations and local transmission patterns
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