Impact of HIV preexposure prophylaxis prescriptions on HIV diagnoses in New York City

Abstract

Background: HIV preexposure prophylaxis (PrEP) has proven to be efficacious and effective in preventing HIV infections, but few studies have reported its impact in the real world. Methods: We conducted an ecological analysis and compared the trends in HIV PrEP prescriptions with the trends in age-adjusted HIV diagnosis rates in New York City (NYC). Joinpoint regression analyses were used to identify any temporal trends in HIV diagnosis rates in NYC. Results: The number of people filling at least one PrEP prescription in NYC increased from 2551 in 2014 to 35 742 in 2022. The overall age-adjusted HIV diagnosis rate steadily decreased from 48.1 per 100 000 in 2003 to 17.1 per 100 000 in 2022. After the rollout of PrEP, accelerated decreases were detected in some subpopulations including white men [2014–2019 annual percentage change (APC): −16.6%; 95% confidence interval (CI) −22.7 to −10.0], Asian/Pacific Islander men (2016–2022 APC: −9.8%), men aged 20–29 years (2017–2020 APC: −9.4%) and 40 –49 years (2014–2020 APC: −12.2%), Latino/Hispanic people aged 40–49 years (2015–2020 APC: −13.0%), white people aged 20–29 years (2012–2022 APC: −11.4%) and 40–49 years (2014–2018 APC: −27.8%), and Asian/Pacific Islander people aged 20–29 years (2017–2022 APC: −13.0%). Conclusion: With a high coverage, PrEP can have a long-term impact in reducing HIV infections in a population, but if preexisting social determinants that contribute to racial, ethnic, and gender inequities are not well addressed, the implementation of PrEP can exacerbate these inequalities.