We sat down with Aaron Siegler, PhD MHS, Research Assistant Professor of Epidemiology at Emory University’s Rollins School of Public Health to discuss the importance of AIDSVu’s newly released data and maps on PrEP use, and how they can be utilized by researchers.
Q: AIDSVu recently launched the first-ever maps visualizing PrEP use at the state-level across the country. Why is it important to have these data available?
A: It’s important to understanding PrEP use at a national level, and AIDSVu’s platform is one of the great tools to help us do that. Making the data easily accessible as a public resource and being able to track PrEP uptake across the U.S. has great public health value. Typically, we publish our research in academic journals and our datasets are only moderately available or not available at all, and lack local nuance. AIDSVu changes that paradigm and brings data to the people.
As a researcher I can analyze the data but the ability for people to incorporate that data into the fabric of how they think – how health departments track state progress, or how community advocates talk to their state legislatures – that’s really powerful.
Q: What do these new data findings contribute to the PrEP discussion?
A: AIDSVu’s new PrEP use data add a different dimension to our understanding because the previously available metrics were counting all persons who had ever started a PrEP prescription. However, there is an important need to also understand the number of individuals who are actively using PrEP, or the total amount of people attaining PrEP protection during a period of time. People who initiate PrEP may stop over time or restart at a later time, so these data are extremely powerful as they are closer to a real-time snapshot of PrEP use and can more accurately inform other components such as program planning and advocacy.
Aside from enabling us to contribute to PrEP awareness, the presentation of these data also required AIDSVu to specify data methodology and sourcing. This specificity adds to the discussion of what these data mean and what other categories we need to build on these data for the future.
Q: As a researcher, how have you utilized these data?
A: In a poster released at the Conference on Retroviruses and Opportunistic Infections (CROI) this week, we analyzed PrEP use data to create what we’re calling a PrEP-to-need ratio. We created this ratio to understand the number of PrEP prescriptions in a geographic area in relation to the number of new HIV diagnoses in that area. The greatest utility is in whether the relative levels of PrEP are equal or unequal across different areas of consideration.
We looked at this PrEP-to-need ratio across a number of different factors. For example, we looked at it across male to females, and we found that the PrEP-to-need ratio in females was 0.4, and the PrEP-to-need ratio in males was 1.8 (0.4 prescriptions per new HIV diagnosis nationally among women, and 1.8 PrEP prescriptions per new HIV diagnosis among males). This tells us that PrEP is scaling up at a disproportionately lower level for women than it is for men based on new HIV diagnoses.
We found similar disparities across states. Our PrEP-to-need analysis shows us that states with a larger concentration of African American populations have lower concentrations of PrEP use relative to epidemic need, and that states that expanded Medicaid have more PrEP use relative to the epidemic.
As a country we need to keep making PrEP more accessible, more available, and have interventions and programs to facilitate that. But, we have to remember that PrEP may not be reaching the groups most in need and as we work to expand PrEP uptake, we also have to make sure that we are reaching these disadvantaged groups.
Q: You’ve worked extensively on PrEP access with the PrEP Locator and PrEP@Home. Can you tell us about those projects and how they decrease barriers to PrEP uptake?
A: PrEP Locator is a project I am really excited about. Our idea was to develop a database of providers willing to prescribe PrEP and to do that from a large variety of sources. We brought in data from state and local health departments and community-based organizations. We also brought in sources from web searches and medical professional organizations. Then we developed a standard way of assessing whether a clinic would be eligible for inclusion in the locator database.
However, when vetting these sources, we found that about a quarter of the clinics would not be eligible for inclusion in the locator. We found that some did not have appropriate medical licensure, or some were referral services only. There are also a lot of clinicians who felt uncomfortable prescribing PrEP and who have previously never prescribed this type of medication.
We translated this data into PrEPLocator.org, a national directory of more than 2,000 providers of PrEP in the U.S that helps individuals identify PrEP services in their community.
PrEP@Home is an intervention that is currently in development to address one of the barriers to care faced by individuals who are trying to access PrEP. Using medicine for HIV prevention currently requires four annual in-person visits with a clinician. For individuals who are not seeing clinicians frequently, that is a very heavy burden. This program allows three of the four visits to be conducted from the convenience of your home via secure technology, alleviating that in-person appointment burden.
Q: What do you see as the future of PrEP research? What questions need to be addressed most urgently?
A: The future of PrEP research needs to have more granular data on the uptake of PrEP by race, and by finer geographic regions, as we try to offer a more nuanced and contextualized picture of how PrEP is scaling up nationally.
I also think combination HIV prevention packages are really important. PrEP is great, but it exists in a broader continuum of HIV prevention, and we need to create a synergy between HIV testing, STD testing, and treatment. The PrEP use data that AIDSVu released has the power to serve as a metric to help us understand the relation with these other areas.