Long‐term retention in pre‐exposure prophylaxis care among men who have sex with men and transgender women in the United States

Abstract

Introduction Retention in HIV pre‐exposure prophylaxis (PrEP) care in real‐world settings, outside of controlled trials or demonstration projects, remains poorly understood. Methods We evaluated retention in PrEP care outcomes among men who have sex with men (MSM) and transgender women prescribed PrEP through March 2017 at three clinical sites in the United States (US): Jackson, Mississippi; Providence, Rhode Island; and St. Louis, Missouri. We determined retention rates by attendance of clinical visits every three months, per US Centers for Disease Control and Prevention (CDC) guidelines, as well as by the timing of patients’ actual clinical visits. Multivariable analyses examined demographic and behavioural factors associated with retention. Results From 2013 to 2015, 282 MSM and transgender women were prescribed PrEP; 82% attended a follow‐up visit. Based on CDC recommendations, 56% of patients were retained in PrEP care at the first follow‐up visit, having attended a visit three months after initiation. However, 76% had a follow‐up visit within eight months. Thirty‐percent were retained at 12 months by CDC criteria, but 62% were retained when using a 16‐month endpoint. Self‐reported adherence was strongly correlated with retention. In multivariable analyses, younger age was associated with decreased odds of retention at initial follow‐up, and completing college was associated with increased odds of retention at 16 months. Eight participants were newly diagnosed with HIV; six were African American, and seven were under 30 years of age. Conclusions Measuring retention in PrEP care using three‐month follow‐up intervals may underestimate true retention. Nevertheless, retention in PrEP care is suboptimal in real‐world settings and should be the focus of future interventions.

Understanding pre-exposure prophylaxis (PrEP) regimen use: Switching and discontinuing daily and event-driven PrEP among men who have sex with men

“…Nevertheless, overall discontinuation rates in our study were comparatively low: other demonstration projects found similar rates over much shorter follow-up time [ 20 , 27 , 28 ] and higher discontinuation rates were observed in larger-scale clinical or primary care implementation settings [ 13 , 29 ]. As our project is one of the few offering a choice of PrEP regimens, PrEP discontinuation might be low when having access to an alternative, non-daily regimen.…”

“…Despite its importance, long-term retention rates and characteristics of those who are not retained are understudied in real-life settings. The few studies addressing retention have shown that those who discontinue PrEP or are not retained in PrEP care are usually younger [ 12 , 13 ] and have a decreased perceived risk of HIV [ 12 , 14 ]. However, median follow-up time was generally one year or shorter in these studies.…”

Characterization of HIV Preexposure Prophylaxis Use Behaviors and HIV Incidence Among US Adults in an Integrated Health Care System

“…However, many individuals may need ongoing support beyond the first several months of PrEP use to ensure sustained use throughout periods of HIV risk. 12 , 13 , 45 An analysis of administrative pharmacy records by Coy et al 13 found that nearly two-thirds of all PrEP users at a national chain pharmacy had discontinued PrEP by the second year. Our results are consistent with those findings.…”

“…Although several studies have evaluated the PrEP continuum in real-world settings, existing data have largely relied on small patient samples or administrative insurance databases with incomplete clinical information. 9 , 10 , 11 , 12 , 13 , 14 , 15 Comprehensive long-term follow-up data are needed to accurately evaluate PrEP continuum outcomes and identify individuals most at risk for falling out of care and acquiring HIV.…”

Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing

“…Current practice guidelines suggest that GBM follow up with their medical provider every 3 months while they are on PrEP for HIV and sexually transmitted infection (STI) testing and kidney function monitoring, among other things [ 19 ], but in practice, patients using PrEP often follow up less frequently [ 20 , 21 ]. Similarly, practice guidelines recommend providing adherence counseling to all patients using PrEP [ 19 ], but it is not clear how many patients using PrEP actually receive some form of counseling.…”