High Rate of Discontinuation May Diminish PrEP Coverage Among Young Men Who Have Sex with Men

Morgan, Ethan; Ryan, Daniel T.; Newcomb, Michael E.; Mustanski, Brian

doi:10.1007/s10461-018-2125-2

Cited by 87 publications

(72 citation statements)

References 7 publications

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“…Persistence (i.e., continuing to take PrEP while the adolescent remains at risk for acquiring HIV) is another important factor. A study of young MSM (aged 16-29 years) reported that 33% of 197 males who reported using PrEP in the past 6 months had discontinued PrEP by the time of the study interview (94). The most commonly reported reasons for discontinuing PrEP included difficulty getting to appointments, lapse in insurance coverage, and perception of being no longer at risk for HIV (94).…”

Section: Medication Initiation Adherence and Persistencementioning

confidence: 99%

“…A study of young MSM (aged 16-29 years) reported that 33% of 197 males who reported using PrEP in the past 6 months had discontinued PrEP by the time of the study interview (94). The most commonly reported reasons for discontinuing PrEP included difficulty getting to appointments, lapse in insurance coverage, and perception of being no longer at risk for HIV (94). Regular screening for the need and desire to continue with PrEP is part of the ongoing care of an adolescent prescribed PrEP.…”

Section: Medication Initiation Adherence and Persistencementioning

confidence: 99%

See 1 more Smart Citation

Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents: Clinical Considerations, 2020

Tanner¹,

Miele²,

Carter³

et al. 2020

MMWR Recomm. Rep.

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Section: Medication Initiation Adherence and Persistencementioning

confidence: 99%

Section: Medication Initiation Adherence and Persistencementioning

confidence: 99%

Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents: Clinical Considerations, 2020

Tanner¹,

Miele²,

Carter³

et al. 2020

MMWR Recomm. Rep.

View full text Add to dashboard Cite

“…After PrEP initiation, safe and effective use depends on adherence to the medication, retention in routine PrEP medical monitoring, and consistent use during periods of high-risk behaviors. Difficulty adhering to these behaviors contributes to reduced protection against HIV infection among BLMSM and BLTW PrEP users [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

et al. 2020

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Purpose Disparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen. Methods In-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data. Results Four themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence. Conclusions PrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.

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“…However, discontinuations of PrEP use among individuals with ongoing risks for acquiring HIV could decrease the effectiveness of PrEP [10,11]. Observational studies of PrEP prescribing in healthcare settings have demonstrated that many patients who initiate PrEP subsequently discontinue its use [12][13][14][15].…”

Section: Introductionmentioning

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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High Rate of Discontinuation May Diminish PrEP Coverage Among Young Men Who Have Sex with Men

Cited by 87 publications

References 7 publications

Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents: Clinical Considerations, 2020

Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents: Clinical Considerations, 2020

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

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

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