This study also highlights urgent data challenges that need to be addressed to foster more accurate research on HIV and substance use disorder, particularly research conducted with observational data. For example, diagnosis codes for tracking opioid use disorder and injection behaviors are imperfect, and medical claims do not fully capture those in need of care because individuals do not seek care for these issues. Therefore, our study may have missed individuals with opioid use disorder or individuals who inject drugs who were misclassified as having no evidence of injecting.
These data challenges suggest that the individuals we included in our study were those with the most severe substance use issues including people who feel they need to seek care for their substance use, those who have providers who decide the use is worthy of documentation, and individuals who seek treatment for injection-related complications of substance use. These are also individuals with some of the greatest risks of becoming infected with HIV, which increases our concern about the alarmingly low PrEP prescribing we found.
To achieve the public health goal of reducing new HIV infections, we need to meaningfully engage with people who inject drugs and employ evidence-based prevention strategies. We need better ways of identifying those who would benefit from PrEP in claims data, but even an imperfect approach shows striking gaps. Aggressive expansion of PrEP for people who inject drugs is urgently needed.
The study, “Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use,” was published in JAMA Network Open on July 12, 2022. Authors include Carl G. Streed Jr, MD, MPH; Jake R. Morgan, PhD; Mam Jarra Gai, MPH; Marc R. Larochelle, MD, MPH; Michael K. Paasche-Orlow, MD, MPH; and Jessica L. Taylor, MD.