Discontinuation of HIV Pre-Exposure Prophylaxis among people in serodifferent relationships: Findings from a programmatic surveillance study within a large-scale HIV program in Nigeria

Abstract

BACKGROUND: As Oral PrEP scales across countries, more information about uptake, use pattern and client preference emerge from pilots, demonstration studies and national programmes. The findings are useful for refining service provision and providing learnings on how oral PrEP and other prevention products or methods can be effectively incorporated into routine health services. Our study examines factors associated with discontinuation of PrEP across two large scale programs in Nigeria to present findings representative of real-world programmatic implementation. METHODS: Through programmatic surveillance of program implementation data from two large-scale HIV projects in Nigeria, we explored early discontinuation of PrEP and associated factors among HIV-negative individuals who initiated PrEP between January 2020 and July 2021 using multivariable logistic regression. RESULTS: Of 26,325 HIV-negative individuals who started PrEP, 84% (22,034) discontinued PrEP within the first month. Factors associated with early discontinuation of PrEP were commencing oral PrEP in the community, being unmarried, engaging in high-risk sexual behaviour, and inconsistent use or non-use of condoms. CONCLUSION: Early discontinuation of PrEP was high, especially for individuals who commenced in the community and reported marital status as “never married”. It was also high among individuals who reported inconsistent use or non-use of condoms. We recommend the strengthening of follow-up counselling to re-assess risk determination, especially between initiation and the first follow-up visit within the health facilities as well as the community-based distribution sites.

A behavioral economics approach to enhancing HIV preexposure and postexposure prophylaxis implementation

“…The PrEP dropout rate is even higher in regions with higher HIV prevalence. For example, in Nigeria, 84% of the patients discontinued PrEP within the first month after initiation [8]. This casts a shadow on the long-term sustainability of oral PrEP.…”