Why Do HIV Pre-Exposure Prophylaxis Users Discontinue Pre-Exposure Prophylaxis Care? A Mixed Methods Survey in a Pre-Exposure Prophylaxis Clinic in Belgium

Abstract

It remains unclear why patients discontinue HIV pre-exposure prophylaxis (PrEP) care and to what extent they remain at risk for HIV when they do. We reviewed routinely collected medical records and patient questionnaires and performed an e-mail/telephone survey to assess reasons for discontinuing PrEP care, ongoing risks for HIV infection, and associated factors. Patients with more than two registered PrEP visits from a PrEP clinic in Antwerp, Belgium between June 2017 and February 2020 were included in this study. Patients who did not return for a visit after October 30, 2019 and who were not transferred out were considered as having discontinued PrEP care. A total of 143/1073 patients were considered as having discontinued PrEP care. Patients who discontinued PrEP care were more likely to be younger than those who remained in care (35 vs. 38 years old, p < 0.01). The most common reasons for discontinuation were having stopped using PrEP (62/101, 61.4%) and “COVID-19” ( n = 35, 34.7%). The most common reasons for stopping PrEP use was a decreased sexual activity due to coronavirus disease 2019 (COVID-19; 21/62, 33.9%) or not COVID-19 related (10/62, 16.1%), a monogamous relationship (20/62, 32.3%) and consistent condom use (7/62, 11.3%). Among respondents who reported about current HIV risk the majority reported being at low risk either by still taking PrEP (32/91, 35.2%), consistently using condoms, or limiting number of sex acts or partners (58/91, 52.7%). No HIV seroconversion was reported.

Is HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men Effective in a Real-World Setting? Experience with One-On-One Counseling and Support in a Sexual Health Center in Paris, 2018–2020

“…Although this indicator did not include all risk factors (notably the number of partners in the previous months), it highlighted the variety of PrEP indications and the absence of a clear risk threshold. This finding seems concordant with studies reporting low risk as a motive for discontinuing PrEP follow-up [ 8 , 9 , 10 ]. In total, 20 patients were not considered as retained in PrEP, including 15 patients who stopped PrEP or were followed elsewhere, and the 5 patients with an unsuccessful follow-up.…”

PrEP Use and HIV Incidence Among Youth At-Risk for HIV Infection in Los Angeles and New Orleans: Findings From ATN 149

“…Early discontinuation of PrEP is also an issue in Australia 10 and Belgium. 25 Barriers to remaining on PrEP include substance use, mental health conditions, housing loss, and difficulty accessing PrEP because of the time and costs of clinic visits. Low self-perceived risk, younger age, and cannabis use also predicted discontinuation.…”

Avaliação do conhecimento da profilaxia pré exposição ao HIV pelos estudantes de Medicina da Universidade de Vassouras-RJ

“…Como exemplo dessas dificuldades temos as elevadas taxas de descontinuação desse método pelos pacientes e a falta de conhecimento tanto dos profissionais das áreas de saúde, como também de estudantes dessas áreas. Desse modo, nota-se a necessidade de introduzir esse conhecimento nessa parcela da população com o objetivo de formar profissionais capacitados no que se refere a PrEP e seus benefícios (Vanbaelen et al, 2022). É de suma importância ressaltar que a profilaxia pré-exposição caminha juntamente com outros métodos de prevenção, o que chamamos de prevenção combinada, como preservativos masculinos e femininos, e podendo também ser incluído no pacote as testagens para o HIV (Gonçalves et al, 2020).…”