title: Dramatic increase in preexposure prophylaxis use among MSM in Washington state.
abstract: HIV preexposure prophylaxis (PrEP) is efficacious, but uptake has been slow. In Washington State, most insurance plans, including Medicaid, pay for PrEP, and the state supports a PrEP drug assistance program. We assessed trends in PrEP awareness and use among MSM in Washington.
  
  
  
  Serial cross-sectional survey conducted annually at the Seattle Pride Parade between 2009 and 2015.
  
  
  
  In a convenience sample of MSM who reside in Washington State and deny ever testing HIV positive (n = 2168), we evaluated the association between calendar year and self-report of PrEP uptake and awareness using descriptive statistics and multivariable relative risk and logistic regression. Regression models included HIV risk and demographic covariates.
  
  
  
  In 2015, 23% [95% confidence interval (CI): 16%, 31%] of high-risk MSM reported currently taking PrEP. The percentage of high-risk MSM who reported ever taking PrEP increased from 5% in 2012 to 31% in 2015. PrEP use among lower-risk MSM was low and stable, between 1 and 3% in 2012-2015. In multivariable analyses, PrEP use was associated with later calendar years (2015 vs. 2012: adjusted relative risk = 2.29, 95% CI: 1.16, 4.52) and elevated HIV risk (adjusted relative risk = 2.92, 95% CI: 2.00, 4.25). The percentage of high and lower-risk MSM who had heard of PrEP increased from 13 to 86% and from 29 to 58%, respectively.
  
  
  
  PrEP awareness is high and the use has rapidly increased over the last year among MSM in Seattle, Washington, USA. These findings demonstrate that high levels of PrEP use can be achieved among MSM at high-risk for HIV infection.
authors.affiliation: aPublic Health - Seattle and King County, HIV/STD Program bDepartment of Epidemiology cDepartment of Medicine, University of Washington, Seattle dWashington State Department of Health, Infectious Disease Prevention, Tumwater, Washington, USA.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Hood
authors.forename: Susan E
authors.initials: SE
authors.lastname: Buskin
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dombrowski
authors.forename: David A
authors.initials: DA
authors.lastname: Kern
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Barash
authors.forename: David A
authors.initials: DA
authors.lastname: Katz
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
mesh_terms: D000328:Adult; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis; D014861:Washington