PMID- 32529552
OWN - NLM
STAT- MEDLINE
DCOM- 20211012
LR  - 20211012
IS  - 1920-7476 (Electronic)
IS  - 0008-4263 (Print)
IS  - 0008-4263 (Linking)
VI  - 112
IP  - 1
DP  - 2021 Feb
TI  - Trends in HIV pre-exposure prophylaxis uptake in Ontario, Canada, and impact of 
      policy changes: a population-based analysis of projected pharmacy data 
      (2015-2018).
PG  - 89-96
LID - 10.17269/s41997-020-00332-3 [doi]
AB  - OBJECTIVES: HIV pre-exposure prophylaxis (PrEP) is a proven tool for HIV 
      prevention, but PrEP use in Ontario, Canada, and the effects of recent policies 
      are unknown. We estimated the number and characteristics of PrEP users in Ontario 
      and evaluated the impacts of policy changes between July 2015 and June 2018. 
      METHODS: We obtained tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) 
      dispensation data for Ontario from IQVIA, and applied an algorithm to identify 
      use for PrEP. We report prevalent PrEP use for the second quarter of 2018 
      according to age, sex, region, prescriber specialty, and payer type, and generate 
      "PrEP-to-need ratios" (PNR) by dividing these numbers by the estimated numbers of 
      new HIV diagnoses. We used interventional autoregressive integrated moving 
      average models to examine the impact of three policy changes on PrEP use: Health 
      Canada approval (February 2016), availability of generic TDF/FTC and partial 
      public drug coverage (September 2017), and public drug coverage for individuals 
      aged < 25 years (January 2018). RESULTS: The estimated number of individuals 
      receiving PrEP increased 713%, from 374 in 2015 Q3 to 3041 in 2018 Q2. Among PrEP 
      users in 2018 Q2, 97.5% were male, 60.4% were < 40 years, 67.7% obtained PrEP 
      from a family physician, 77.2% used private insurance, and 67.0% were in Toronto. 
      PNRs were highest in 30-39-year-olds, males, Toronto and the Central East and 
      West regions. Time series analyses found that Health Canada approval (p = 0.0001) 
      and introducing generics/partial public drug coverage (p = 0.002) led to 
      significantly increased use. CONCLUSIONS: PrEP use has risen in Ontario in 
      association with favourable policy changes, but remains far below guideline 
      recommendations.
FAU - Tan, Darrell H S
AU  - Tan DHS
AD  - Division of Infectious Diseases, St. Michael's Hospital, Toronto, ON, Canada. 
      Darrell.tan@gmail.com.
AD  - MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St., 
      Toronto, ON, M5B 1W8, Canada. Darrell.tan@gmail.com.
AD  - Department of Medicine, University of Toronto, Toronto, ON, Canada. 
      Darrell.tan@gmail.com.
AD  - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 
      Darrell.tan@gmail.com.
FAU - Dashwood, Thomas M
AU  - Dashwood TM
AD  - Department of Medicine, University of Toronto, Toronto, ON, Canada.
FAU - Wilton, James
AU  - Wilton J
AD  - Ontario HIV Treatment Network, Toronto, ON, Canada.
FAU - Kroch, Abigail
AU  - Kroch A
AD  - Ontario HIV Treatment Network, Toronto, ON, Canada.
FAU - Gomes, Tara
AU  - Gomes T
AD  - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
AD  - Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
FAU - Martins, Diana
AU  - Martins D
AD  - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
LA  - eng
GR  - CIHR/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200611
PL  - Switzerland
TA  - Can J Public Health
JT  - Canadian journal of public health = Revue canadienne de sante publique
JID - 0372714
SB  - IM
MH  - Adult
MH  - Female
MH  - *HIV Infections/prevention & control
MH  - Humans
MH  - Male
MH  - Ontario
MH  - Pharmacy
MH  - *Policy
MH  - *Pre-Exposure Prophylaxis/statistics & numerical data/trends
PMC - PMC7851246
OTO - NOTNLM
OT  - HIV
OT  - Policy
OT  - Pre-exposure prophylaxis
OT  - Prevention and control
OT  - Public health
COIS- In the past 3 years, DHST's institution has received research support for 
      investigator-initiated research studies from Gilead Sciences and Viiv Healthcare, 
      outside the submitted work. DHST is a Site Principal Investigator for clinical 
      trials sponsored by Glaxo Smith Kline, outside the submitted work.
EDAT- 2020/06/13 06:00
MHDA- 2021/10/13 06:00
PMCR- 2020/06/11
CRDT- 2020/06/13 06:00
PHST- 2019/12/11 00:00 [received]
PHST- 2020/04/28 00:00 [accepted]
PHST- 2020/06/13 06:00 [pubmed]
PHST- 2021/10/13 06:00 [medline]
PHST- 2020/06/13 06:00 [entrez]
PHST- 2020/06/11 00:00 [pmc-release]
AID - 10.17269/s41997-020-00332-3 [pii]
AID - 332 [pii]
AID - 10.17269/s41997-020-00332-3 [doi]
PST - ppublish
SO  - Can J Public Health. 2021 Feb;112(1):89-96. doi: 10.17269/s41997-020-00332-3. 
      Epub 2020 Jun 11.