Expansion of access to PrEP and usage of 'priority patient' criteria for PrEP initiation, along with direct feedback to clinicians, was associated with decreased disparities in PrEP discussions overall and prescriptions among MSM at Baltimore City Health Department Sexual Health Clinics over 2016-2023.
Key Findings
Results
PrEP discussions among priority patients increased substantially over the 8-year study period.
PrEP discussions increased from 42% in the earliest period to 70% in the latest period.
The study observed 8,672 priority patients across 8 years (2016-2023).
Three time periods were analyzed: 2016-2019 (program establishment and scale-up), 2020-2021 (COVID-19-impacted), and 2022-2023 (rapid PrEP expansion and targeted provider feedback).
Multivariable regression was used to analyze relative differences in PrEP discussions across the three time periods.
Results
PrEP prescriptions among all priority patients increased over the study period.
PrEP prescriptions among all priority patients increased from 14% to 34% over time.
The priority for PrEP initiation group was based on clinical and epidemiologic indications for PrEP.
Data were drawn from routinely collected patient demographic, sexual history, substance use, clinical, and treatment data from electronic health records.
Results
Significantly lower PrEP discussion rates were observed among cisgender women, straight cisgender men, and MSM aged 30 years or older in all time periods, though disparities decreased over time.
Regression identified significantly lower discussions among cis women, straight cis men, and MSM of age ≥30 years in all three time periods.
The magnitudes of these disparities decreased over time across the study period.
Analysis used multivariable regression to identify relative differences in patient-clinician PrEP discussions.
Results
Significant racial and ethnic disparities in PrEP prescriptions existed among MSM in 2016-2019, with Black MSM under age 30 receiving fewer prescriptions compared to non-Black/non-Latino MSM and Latino MSM.
Compared with Black MSM of age <30 years, significantly more prescriptions were observed among non-Black/non-Latino MSM (+29%) in 2016-2019.
Compared with Black MSM of age <30 years, significantly more prescriptions were observed among Latino MSM (+60%) in 2016-2019.
Black MSM under age 30 served as the reference group for prescription comparisons.
Results
Racial and ethnic disparities in PrEP prescriptions among MSM decreased or lost statistical significance by 2022-2023.
By 2022-2023, the disparity between Black MSM <30 years and non-Black/non-Latino MSM lost statistical significance.
By 2022-2023, the disparity between Black MSM <30 years and Latino MSM decreased (though the Latino MSM disparity did not fully disappear).
The 2022-2023 period was characterized by expansion of rapid PrEP and targeted provider feedback concerning missed opportunities for PrEP discussions.
Methods
The study setting encompassed Baltimore City Health Department Sexual Health Clinics serving a priority population defined by clinical and epidemiologic PrEP indications.
Data were collected from Baltimore City Health Department Sexual Health Clinics from 2016 to 2023.
The study population consisted of 8,672 priority patients observed over 8 years.
Patient data included demographics, sexual history, substance use, clinical, and treatment information from electronic health records.
The 'priority for PrEP initiation' group designation was based on clinical and epidemiologic indications for PrEP.
What This Means
This research studied how often patients at Baltimore City sexual health clinics were offered discussions about PrEP (a medication that prevents HIV) and how often they actually received a PrEP prescription, looking at trends from 2016 to 2023. The study focused on 8,672 patients who were considered high-priority for PrEP based on their health history and risk factors. Over the 8-year period, the share of priority patients who had a PrEP discussion with their provider grew from 42% to 70%, and PrEP prescriptions grew from 14% to 34%.
The study also found that certain groups were less likely to receive PrEP discussions or prescriptions, revealing health disparities. Cisgender women, straight cisgender men, and gay/bisexual men (MSM) aged 30 and older were consistently less likely to have PrEP discussions compared to younger MSM, though these gaps narrowed over time. Among MSM specifically, Black patients under age 30 received fewer prescriptions than Latino MSM (who were 60% more likely to receive a prescription) and non-Black/non-Latino MSM (29% more likely) in the earliest years of the study. By 2022-2023, after the clinic introduced rapid PrEP access and began giving providers direct feedback about missed PrEP conversations, these prescription disparities among MSM substantially decreased or became statistically insignificant.
This research suggests that targeted clinic-level interventions — such as expanding rapid access to PrEP and providing feedback to healthcare providers about missed opportunities — can help reduce racial and demographic inequities in HIV prevention care. The findings are relevant to national goals to end the HIV epidemic, which depend not only on increasing overall PrEP use but on ensuring that people most affected by HIV, including Black MSM, have equitable access to prevention tools.
Stracker N, Rives S, Schumacher C, Hamill M, Greenbaum A, Rosecrans A. (2025). Addressing Health Disparities Associated With the HIV PrEP Initiation Cascade, Baltimore City Health Department Sexual Health Clinics, 2016-2023.. Journal of acquired immune deficiency syndromes (1999). https://doi.org/10.1097/QAI.0000000000003764