HIV pre-exposure prophylaxis among people initiating buprenorphine for opioid use disorder: a retrospective cohort study

IntroductionBuprenorphine (BUP) is an effective treatment for opioid use disorder (OUD) that may create opportunities to expand access to preventive services for patients with OUD when implemented in the primary care setting. HIV prevention, particularly pre-exposure prophylaxis (PrEP), represents a vital service for persons with OUD due to HIV risk associated with injection drug use and condomless sex. Evaluating the existing integration of BUP treatment and HIV prevention is an important step to further optimize comprehensive care for patients with OUD. MethodsThis retrospective cohort study used pharmacy claims from the Merative MarketScan(R) Research Databases, 2014 - 2022, to examine use of PrEP among new BUP treatment episodes over the first 63 days of treatment. We excluded BUP episodes from individuals with probable HIV (based on diagnosis or medications indicated for HIV in the past 365 day). Clinical indications for PrEP were identified based on past 365-day diagnosis of sexually transmitted infections (STIs) or serious injection-related infections (SIRIs). ResultsOf 123,740 BUP episodes representing 76,377 individuals, 104 (0.1%) involved PrEP during BUP treatment. Most of these episodes (71%) involved PrEP in the 30 days prior to BUP initiation. Only 6% of the sample exhibited diagnoses indicating risk for HIV. Of these, only 0.2% involved PrEP during the BUP treatment episode. BUP episodes involving PrEP tended to be disproportionately male (89% compared with 63%) and from the Northeast (27% vs. 18%) or West (30% vs. 16%). ConclusionsFindings from this retrospective cohort study identify a major gap in PrEP use for individuals with OUD and documented HIV risk. Aligning HIV prevention and BUP treatment is an important opportunity to enhance health for patients with OUD.