PrEP is a proven, effective means of preventing HIV. Uptake in groups at highest risk of HIV, such as Black men who have sex with men (MSM) and Hispanics, has been disproportionately low nationwide. We analyzed the demographics of PrEP patients in the STAR Health Center in East Flatbush, Brooklyn (BK) to assess our effectiveness in PrEP uptake and retention among at-risk groups.
We performed a retrospective analysis of 134 consecutive patients who enrolled in our clinic for PrEP between June 2016 and December 2017. We assessed risk factors, demographics, insurance status, location and retention in care. Retention was defined as completing medical visits within 3 months of prior visit. We compared demographics, sexual practices and locations of our patients to those among new HIV diagnoses in BK, as reported by NYC’s Department of Health’s 2016 surveillance report. Fisher’s exact test was used to detect differences in gender, race, and sexual practices.
Only 11.94% of those enrolled in our clinic and prescribed PrEP were women, compared to 27.19% of BK new HIV diagnoses (p <0.005). There was no statistically significant difference in race, and distributions were similar between the two groups. There was a higher proportion of MSM among those prescribed PrEP (71.64%) compared to BK new HIV diagnoses (46.64%) (p < 0.005). Retention rates were low, with female gender (6/16, 37.5%) and White race (12/32, 37.5%) having the lowest retention in care, compared to Hispanic patients (13/21, 61.90%) who had highest retention. 41.04% of PrEP patients were uninsured. ZIP codes with highest HIV incidence per NYC’s Department of Health surveillance report were well represented in our clinic for PrEP.
In STAR, PrEP uptake was similar across race and location when compared to people who newly acquired HIV. There was a larger proportion of individuals known to be MSM among those prescribed PrEP. This study shows that STAR’s efforts at targeting at-risk groups are reaching the appropriate demographics. However, there was a detectable disparity in PrEP uptake in women. Research into further interventions to increase PrEP access for women and improve retention overall is needed. Nevertheless, STAR’s program presents a model to follow for other areas with disparities in PrEP uptake among at-risk groups.
D. Stefanov, None