Individuals With Highest HIV Infection Rates Insured by Medicaid Less Likely to Persist With HIV Pre-Exposure Prophylaxis

Study authors estimated pre-exposure prophylaxis persistence among cohorts of patients with commercial vs Medicaid insurance.

Fewer patients insured by Medicaid persisted with pre-exposure prophylaxis (PrEP) for prevention of HIV. These findings were published in Clinical Infectious Diseases.

Researchers from the Centers for Disease Control and Prevention analyzed data from the IBM MarketScan Commercial Claims and Encounters (commercial insurance) and Multi-State Medicaid (Medicaid insurance) databases, which encompassed approximately 20% of insured Americans between 2012 and 2017. Individuals were assessed for persistence of PrEP, as defined by no prescription interruption for greater than 30 days.

A total of 11,807 patients covered by commercial insurance and 647 patients covered by Medicaid were included in this analysis. Among the commercial and Medicaid cohorts, 97.7% and 77.6% were men and 60.8% and 63.2% were aged 25-44 years, respectively.

Individuals with commercial insurance persisted on PrEP for a median of 13.7 months (95% CI, 13.3-14.1) and those with Medicaid for 6.8 months (95% CI, 6.1-7.6; P <.0001).

Men had longer median persistence (commercial, 13.9 months; Medicaid, 7.1 months) than women (commercial, 6.8 months; Medicaid, 5.8 months).

Stratified by age (18-24 years, 25-34 years, 35-44 years, 45-54 years, and 55-64 years), persistence at 12 months increased with age group among both commercially insured (P <.0001) and Medicaid (P =.0109) cohorts.

Among the Medicaid group, 43.6% were White and 25.8% were Black. Persistence was higher among White individuals (median, 7.3 months) compared with Black individuals (median, 4.7 months; P =.0028).

In the commercial insurance cohort, nonpersistence was 2.4 times more likely to occur in individuals aged 18-24 years compared with individuals aged 55-64 years (hazards ratio [HR], 2.38; P <.0001) and generally more likely in women (aHR, 1.81; 95% CI, 1.56-2.11; P <.0001). Among the Medicaid cohort, nonpersistence was associated with 18-24 years of age (aHR, 1.70; 95% CI, 1.04-2.78; P =.0331) and women (aHR, 1.47; 95% CI, 1.17-1.85; P =.0011).

This study was limited by not having access to information about why individuals chose to discontinue using PrEP. It is possible some stopped use due to adverse effects or behavioral changes which reduced HIV exposure risk.

These data indicated individuals covered by Medicaid who had the highest rates of HIV diagnoses (eg, younger persons and Black individuals) were at higher risk for discontinuing PrEP use.


Huang Y-L A, Tao G, Smith D K, et al. Persistence with human immunodeficiency virus pre-exposure prophylaxis in the United States, 2012–2017. Clin Infect Dis. 2021;72(3):379-385. doi:10.1093/cid/ciaa037.