Preexposure Prophylaxis Initiation and Retention in Care Over 5 Years, 2012–2017: Are Quarterly Visits Too Much?

Rusie, Laura; Orengo, Carlos; Burrell, Diane; Ramachandran, Arthi; Houlberg, Magda; Keglovitz, Kristin; Munar, David; Schneider, John A.

doi:10.1093/cid/ciy160

Cited by 82 publications

(61 citation statements)

References 9 publications

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“…56,57 This may be due, in part, to the guidelines for PrEP initiation and monitoring that can be prohibitive for key populations. [58][59][60][61] Scaling out of PrEP to YBMSM will require considering novel and adapted delivery methods. One strategy to address barriers involves expedited (same day start) PrEP, both within and outside of traditional health care settings.…”

Section: Prep: Scaling Out Of a Biomedical Interventionmentioning

confidence: 99%

“…A "one size fits all" method for PrEP delivery should be reassessed since younger populations may need more frequent interactions to encourage adherence, while older populations may not. 60,61 Implementation research methodologies can be applied to test these hypotheses and provide "differentiated" care based on individual client needs.…”

Section: Prep: Scaling Out Of a Biomedical Interventionmentioning

confidence: 99%

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Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

et al. 2019

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Implementation science has great potential to improve the health of communities and individuals who are not achieving health equity. However, implementation science can exacerbate health disparities if its use is biased toward entities that already have the highest capacities for delivering evidence-based interventions. In this article, we examine several methodologic approaches for conducting implementation research to advance equity both in our understanding of what historically disadvantaged populations would need—what we call scientific equity—and how this knowledge can be applied to produce health equity. We focus on rapid ways to gain knowledge on how to engage, design research, act, share, and sustain successes in partnership with communities. We begin by describing a principle-driven partnership process between community members and implementation researchers to overcome disparities. We then review three innovative implementation method paradigms to improve scientific and health equity and provide examples of each. The first paradigm involves making efficient use of existing data by applying epidemiologic and simulation modeling to understand what drives disparities and how they can be overcome. The second paradigm involves designing new research studies that include, but do not focus exclusively on, populations experiencing disparities in health domains such as cardiovascular disease and co-occurring mental health conditions. The third paradigm involves implementation research that focuses exclusively on populations who have experienced high levels of disparities. To date, our scientific enterprise has invested disproportionately in research that fails to eliminate health disparities. The implementation research methods discussed here hold promise for overcoming barriers and achieving health equity.Ethn Dis. 2019;29(Suppl 1):83-92; doi:10.18865/ed.29.S1.83.

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Section: Prep: Scaling Out Of a Biomedical Interventionmentioning

confidence: 99%

Section: Prep: Scaling Out Of a Biomedical Interventionmentioning

confidence: 99%

Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

et al. 2019

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“…Pre‐exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy when taken during periods of HIV risk [1,2]. Although PrEP persistence (sustained PrEP use over time) was high among PrEP users in clinical trials and early demonstration projects [2‐4], it has been variable among later PrEP adopters and in real‐world evaluations, with 15 to 62% of users discontinuing PrEP by six months [5‐14]. Prevention‐effective adherence is a concept which describes the importance of using PrEP during periods of HIV risk, as compared to antiretroviral therapy, for which lifelong adherence is required [15].…”

Section: Introductionmentioning

confidence: 99%

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) is highly effective, although PrEP adherence and persistence has been variable during real world implementation. Little is known about missed opportunities to enhance PrEP adherence among individuals who later HIV seroconverted after using PrEP. The goal of this analysis was to identify all HIV infections among individuals who had accessed PrEP in an integrated health system in San Francisco, and to identify potentially intervenable factors that could have prevented HIV infection through in‐depth interviews with people who HIV seroconverted after using PrEP. Methods We identified individuals who initiated PrEP in an integrated safety‐net public health system and performed in‐depth chart review to determine person‐time on and after stopping PrEP over six years. We identified all PrEP seroconversions using the Centers for Disease Control and Prevention’s Enhanced HIV/AIDS Reporting System and then calculated HIV incidence while using PrEP and during gaps in use. We then performed in‐depth interviews with those who seroconverted. Results Overall, 986 initiated PrEP across the San Francisco Department of Public Health from July 2012 to November 2018. Data were gathered from 895 person‐years on PrEP and 953 after stopping PrEP. The HIV incidence was 7.5‐fold higher after stopping PrEP compared to while on PrEP (95% CI 1 to 336). Of the eight individuals who HIV seroconverted; only one was taking PrEP at the time of seroconversion but was using on‐demand PrEP inconsistently. All eight agreed to qualitative interviews. Major barriers to PrEP persistence included substance use, mental health and housing loss; difficulty accessing PrEP due to cost, insurance, and the cost and time of medical visits; difficulty weighing PrEP’s benefit versus self‐perceived risk; and entering a primary partnership. The individual who developed HIV using on‐demand PrEP reported confusion about the dosing regimen and which sexual encounters required accompanying PrEP dosing. Conclusions HIV incidence during gaps in PrEP use was nearly eight‐fold higher than while on PrEP in this large cohort in San Francisco. Many individuals who stop PrEP remain at risk of HIV, and participants reported that proactive outreach could potentially have prevented HIV infections. Individuals using non‐daily PrEP may require additional education and support in the United States.

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“…[8][9][10] In addition, required quarterly follow-up clinic visits and laboratory testing have been considered a potential barrier to longer term persistence in PrEP care. [11][12][13][14][15] Indeed, a recent study conducted in San Francisco, a location with robust PrEP care, found that the most common reason for discontinuation was difficulty attending clinic visits or completing laboratory tests. 16 Technological innovations in PrEP delivery systems may help address structural and social challenges related to PrEP uptake and continuity, such as fear of discrimination on the basis of one's sexual identity, difficulty attending clinic visits, or completing laboratory testing.…”

Section: Introductionmentioning

confidence: 99%

“A Good Habit”: Telehealth PrEP Users Find Benefit in Quarterly Monitoring Requirements

Koester

Hughes

Grant

2020

J Int Assoc Provid AIDS Care

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In the United States, uptake of daily oral pre-exposure prophylaxis (PrEP) to prevent HIV continues to grow albeit at a slower than desired pace. Innovations in PrEP delivery systems may partially address structural challenges related to PrEP uptake and PrEP persistence, such as difficulty in attending clinic visits or completing laboratory testing. To study PrEP services offered by a telehealth company called Nurx, we conducted 31 in-depth interviews with prospective or current patients. We hypothesized that patients would find the quarterly laboratory monitoring requirements to be onerous especially in light of receiving all other aspects of PrEP care through a telehealth delivery system. However, interviewees characterized navigating laboratory systems as relatively easy and complying with the quarterly monitoring as a supplementary benefit of PrEP use. Our research illustrates that quarterly monitoring requirements are meaningful to some telehealth PrEP users and may facilitate persistent engagement in receipt of PrEP care.

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Preexposure Prophylaxis Initiation and Retention in Care Over 5 Years, 2012–2017: Are Quarterly Visits Too Much?

Cited by 82 publications

References 9 publications

Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

“A Good Habit”: Telehealth PrEP Users Find Benefit in Quarterly Monitoring Requirements

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