Patterns of PrEP Retention Among HIV Pre-exposure Prophylaxis Users in Baltimore City, Maryland

Abstract

Background: HIV pre-exposure prophylaxis (PrEP) retention, defined as quarterly clinical evaluation, is critical to reducing HIV incidence. Our objectives were to determine: (1) visit- and individual-level PrEP retention patterns; (2) and individual-level characteristics associated with low-level PrEP retention 12 months after initiation among PrEP users in Baltimore City, Maryland. Methods: Information was abstracted from medical records among individuals initiating PrEP between October 1, 2015 and February 28, 2018. Visit-level PrEP retention was defined as evidence of PrEP use, documented PrEP prescription, or current PrEP use at each quarterly follow-up visit. Low-level PrEP retention was defined as <3/4 quarters with documented PrEP use. Multilevel mixed effects Poisson regression was used to determine characteristics associated with low-level PrEP retention. Results: Among 412 individuals initiating PrEP and followed for 12 months, the majority was: cis-gender male (83.7%, n = 345), non-Hispanic Black (56.3%, n = 232) and gay, bisexual, or other man who has sex with men (74.0%, n = 305). By quarterly visits, PrEP retention was: 3-month: 69.4% (n = 286); 6-month: 51.9% (n = 214); 9-month: 44.5% (n = 183); and 12-month: 41.1% (n = 169). Three-fifths (58.5%, n = 241) had low-level PrEP retention. Cis-gender females (vs. cis-gender males) (adjusted relative risk: 1.36, 95% confidence interval: 1.04 to 1.77) were more likely to have low-level PrEP retention. Conclusions: Our observed PrEP retention rates are lower than what may be needed to reduce HIV incidence. Future research should examine individual- and clinic-level barriers and facilitators to PrEP retention programs by key population to inform interventions for PrEP retention.

Effect of an mHealth intervention on retention in HIV pre-exposure prophylaxis services among female sex workers: Preliminary evidence of the use of the Jichunge app in Dar es Salaam, Tanzania

“… 40 One reason for the difference could be that sex work is legal and regulated by policy in Senegal (as opposed to the situation in Tanzania and Kenya), 41 and this could have positive implications for the will to seek and remain in health services. Our findings underscore the considerable challenge of poor retention in PrEP services that has been reported elsewhere 42 , 43 and calls for more and better strategies to support retention in PrEP services.…”

Assessing HIV Pre-exposure Prophylaxis Uptake and Retention Amongst Young Females in Gauteng Province

“…However, the present study looked back on the [4] retention rate criteria and discovered that, young females who were not retained in PrEP would have been considered retained in care if the criteria was used, which is not a true reflection in a real life setting as per the PrEP guidelines. Wu et al [23] concurred and stated that, PrEP must be taken for at least twenty-eight (28) days uninterruptedly following the last high risk HIV exposure to receive the maximum protection from PrEP, this implies that when one interrupt the 28 days of taking PrEP pill, it reduces the level of protection to acquire HIV.…”

A Demedicalized Model to Provide PrEP in a Sexual Health Clinic

“…36 A study that evaluated PrEP programs in 3 mid-size US cities found that only 30% of patients prescribed PrEP continued to receive PrEP follow-up 12 months later, and an analysis of PrEP users in 7 clinical sites in Baltimore City, MO, found that PrEP retention was 41% at 12 months. 37,38 In contrast, a study of PrEP provided through a community-based clinic serving MSM in San Francisco reported that only 38% of patients had discontinued PrEP within 13 months, 39 and an online study of MSM in WA State reported 80% retention at 1 year. 40 In a prior report from our SHC evaluating data from 2014 to 2016, 40% of patients who started PrEP discontinued it at least once within a year.…”