Reasons for PrEP Discontinuation After Navigation at Sexual Health Clinics: Interactions Among Systemic Barriers, Behavioral Relevance, and Medication Concerns

Abstract

Background:Pre-exposure prophylaxis (PrEP) for HIV prevention requires engagement throughout the PrEP care continuum. Using data from a PrEP navigation program, we examine reasons for PrEP discontinuation.Setting:Participants were recruited from New York City Health Department Sexual Health Clinics with PrEP navigation programs.Methods:Participants completed a survey and up to 3 interviews about PrEP navigation and use. This analysis includes 94 PrEP initiators that were PrEP-naive before their clinic visit, started PrEP during the study, and completed at least 2 interviews. Interview transcripts were reviewed to assess reasons for PrEP discontinuation.Results:Approximately half of PrEP initiators discontinued PrEP during the study period (n = 44; 47%). Most participants (71%) noted systemic issues (insurance or financial problems, clinic or pharmacy logistics, and scheduling barriers) as reasons for discontinuation. One-third cited medication concerns (side effects, potential long-term side effects, and medication beliefs; 32%) and behavioral factors (low relevance of PrEP because of sexual behavior change; 34%) as contributing reasons. Over half (53.5%) highlighted systemic issues alone, while an additional 19% attributed discontinuation to systemic issues in combination with other factors. Of those who discontinued, approximately one-third (30%) restarted PrEP during the follow-up period, citing resolution of systemic issues or behavior change that increased PrEP relevance.Conclusions:PrEP continuation is dependent on interacting factors and often presents complex hurdles for patients to navigate. To promote sustained engagement in PrEP care, financial, clinic, and pharmacy barriers must be addressed and counseling and navigation should acknowledge factors beyond sexual risk that influence PrEP use.

Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records

“…Younger age has previously been observed to be associated with lower persistence on PrEP, and indeed with other longer‐term medications [ 14 , 25 ]. We also found that the almost one in five people who received a concessional subsidy (based on income, employment, health, expenditure on medicines or disability) were at lower risk of discontinuation, despite financial barriers being identified as a predictor of discontinuation elsewhere [ 26 ]. This is an encouraging finding, demonstrating the strength of Australia's universal healthcare system.…”

Addressing Disparities in Pre-Exposure Prophylaxis (PrEP) Access: Implementing a Community- Centered Mobile PrEP Program in South Florida

“…Policy barriers related to insurance and pharmacy bene ts can prevent the receipt of PrEP medication after receipt of a PrEP prescription. (20,25) A study of new PrEP prescription holders in New York City reported that systemic issues, including failed attempts at navigating insurance/pharmacy systems, accounted for the largest category of reasons for discontinuation. (25) This is congruent with our nding that individualized patient navigation, aimed at overcoming insurance/pharmacy related barriers, was an important component of the Mobile PrEP intervention.…”

“…(20,25) A study of new PrEP prescription holders in New York City reported that systemic issues, including failed attempts at navigating insurance/pharmacy systems, accounted for the largest category of reasons for discontinuation. (25) This is congruent with our nding that individualized patient navigation, aimed at overcoming insurance/pharmacy related barriers, was an important component of the Mobile PrEP intervention. Participants from all three groups in our study described Mobile PrEP as uncomplicated and easy for clients to use.…”

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

“…A signi cant nding across many studies and programmes is that PrEP users discontinue oral PrEP within 1 to 3 months, and continuation rates are low [9][10][11][12] . Researchers have investigated client-, provider-and system-level perspectives to understand factors that affect oral PrEP continuation; studies done in Eswatini, Kenya, South Africa, US and Uganda highlight reasons such as stigma-related discomforts with accessing PrEP at ART clinics, issues around inconvenient clinic locations or operating hours, long wait times, and short re ll dates [13][14][15] . Clientlevel factors include changes to self-perceived HIV risk, side effects 16 , daily pill burden 9,14 , concealing pills from partner or partner's insistence to discontinue pills 17,18 .…”