PrEP in the Real World: Predictors of 6-Month Retention in a Diverse Urban Cohort

Lankowski, Alexander; Bien-Gund, Cedric H.; Patel, Viraj V.; Felsen, Uriel R.; Silvera, Richard; Blackstock, Oni J.

doi:10.1007/s10461-018-2296-x

Cited by 34 publications

(21 citation statements)

References 14 publications

(14 reference statements)

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“…13 Comparisons now need to be made to determine the rate of follow-up visits in physician-run PrEP clinics to better determine the costs of offering PrEP. Lastly, our retention rate of 50.6% (45/89) matches that in the published literature about PrEP, [22][23][24][25] and with larger reviews about medication adherence more generally, 26 with about half of persons discontinuing any oral medication after about 12 months of use.…”

Section: Discussionsupporting

confidence: 83%

Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

et al. 2021

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ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

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Section: Discussionsupporting

confidence: 83%

Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

et al. 2021

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“…The most common reasons for discontinuing PrEP included decreased HIV risk perception, non‐adherence to care plans, insurance barriers, and medication intolerances. Other studies have also found that changes in HIV risk perception and side effects were common reasons for PrEP discontinuation . This heterogeneity in the reasons for discontinuing PrEP suggests that preventing inappropriate discontinuations will likely require diverse or multifaceted interventions.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective chart review at an academic health system in New York found that retention in PrEP care after six months was 42%. In a national study of over 1000 PrEP users at the Veterans Health Administration, 44% of PrEP users discontinued PrEP within the first year , and 38% of PrEP users at a community‐based clinic in San Francisco discontinued PrEP by 13 months . Similarly, 26% of nearly 5000 patients who initiated PrEP between 2012 and 2017 at an integrated healthcare organization in Northern California discontinued PrEP .…”

Section: Discussionmentioning

confidence: 99%

Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care

et al. 2019

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Introduction Discontinuations of HIV preexposure prophylaxis (Pr EP ) by at‐risk individuals could decrease the effectiveness of Pr EP . Our objective was to characterize patterns of, reasons for, and clinical outcomes associated with Pr EP discontinuations in primary care. Methods We conducted medical chart reviews for patients prescribed Pr EP during 2011 to 2014 at a Boston community health centre specializing in healthcare for sexual and gender minorities. Patients were followed through 2015. We characterized patients’ sociodemographics, relationship status, behavioural health conditions, patterns of and reasons for Pr EP discontinuations, and HIV seroconversions. Cox proportional hazards models were used to assess patient factors associated with Pr EP discontinuations. Results Of the 663 patients prescribed Pr EP , the median age was 33 years, 96% were men who have sex with men ( MSM ) and 73% were non‐Hispanic white; 40% were in committed relationships and 15% had HIV ‐infected partners. Patients either used Pr EP continuously (60%), had 1 or more discontinuations (36%), or did not initiate Pr EP (4%). Discontinuations were most often due to a decrease in HIV risk perception (33%), non‐adherence to care plans (16%), or insurance barriers (12%). Of the 7 (1.1%) Pr EP patients diagnosed with HIV , 1 was HIV ‐infected at baseline, 2 seroconverted while using Pr EP , and 4 seroconverted after discontinuations. In a multivariable model adjusted for race/ethnicity, relationship status, substance use disorders, and insurance status, those who were less than 30 years old ( aHR 2.0, 95% CI 1.4 to 2.9 for ages 18 to 24, aHR 2.2, 95% CI 1.6 to 3.1 for ages 25 to 29, vs. ages 30 to 39 years), who identified as transgender women ( aHR 2.0, 95% CI 1.2 to 3.4, vs. cisgender men), and who had mental health disorders ( aHR 1.2, 95% CI 1.1 to 1.4 for each additional disorder) were more likely to have discontinuations. Conclusions Discontinuations of Pr EP use among this American sample of predominately MSM were common, particularly among patients who were younger, identified as transgender women, or had behavioural health issues. As HIV ...

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“…To estimate overall—as opposed to direct—covariate effects on each measure of PrEP discontinuation [22], we used directed acyclic graphs to select models including all measured confounders of the relationship of each covariate with PrEP discontinuation, based on the prior PrEP retention literature [1, 3, 9, 23], while excluding any mediators. Confounders included in the model for each covariate are listed in the footnotes of Table 2.…”

Section: Methodsmentioning

confidence: 99%

Missed Visits Associated With Future Preexposure Prophylaxis (PrEP) Discontinuation Among PrEP Users in a Municipal Primary Care Health Network

Spinelli

Scott

Vittinghoff

et al. 2019

Open Forum Infectious Diseases

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Background Maintaining retention in preexposure prophylaxis (PrEP) care among diverse patient populations will be needed to support PrEP’s efficacy. We characterized patterns of PrEP care retention in a US municipal primary care health network and examined whether missed visits, a metric of care retention that is easy to evaluate in clinic, are associated with subsequent discontinuation. Methods We included individuals on PrEP from July 2012 until August 2017 in the San Francisco Primary Care Clinics, a 15-clinic municipal health network. We categorized PrEP usage patterns as follows: early discontinuation (<90 days), later discontinuation (after ≥90 days), and continuing use at the end of follow-up. We first examined early discontinuation using adjusted Poisson regression. In patients who continued PrEP for ≥90 days, we examined factors associated with late discontinuation. Results Of the 364 individuals who started PrEP, 16% discontinued PrEP before 90 days, 46% discontinued later, and 38% were retained in care over a median 12 months of observation. Transgender women were more likely to discontinue PrEP early (adjusted risk ratio; 2.16; 95% confidence interval, 1.36–3.49), and younger users were more likely to discontinue late (0.82 per 10-year increase in age; .70–.96), as were persons who use illicit drugs (1.59; 1.02–2.47). Missed visits during use of PrEP were associated with future discontinuation (adjusted risk ratio, 1.52; 95% confidence interval, 1.14–2.03). Later year of current PrEP use was associated with both early and late discontinuation. Conclusion Diverse populations may require differentiated care to continue PrEP. Missed visits should trigger tailored interventions to maximize the impact of PrEP.

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PrEP in the Real World: Predictors of 6-Month Retention in a Diverse Urban Cohort

Cited by 34 publications

References 14 publications

Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care

Missed Visits Associated With Future Preexposure Prophylaxis (PrEP) Discontinuation Among PrEP Users in a Municipal Primary Care Health Network

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