Patterns of Pre-exposure Prophylaxis (PrEP) Use in a Population Accessing PrEP in Jackson, Mississippi

Abstract

Pre-exposure prophylaxis (PrEP) persistence is suboptimal in the United States. In the Deep South, a region with high rates of new HIV diagnosis, patterns of PrEP discontinuation remain unexplored. We evaluated data from a clinic-based PrEP program in Jackson, Mississippi and included patients initiating PrEP between August 2018 and April 2021. We considered patients to have a gap in PrEP coverage if they had at least 30 days without an active PrEP prescription; those who restarted PrEP after 30 days were classified as ‘stopped and restarted’ and those who never obtained a new PrEP prescription were classified as ‘stopped and did not restart’. Patients without a gap in coverage were considered ‘continuously on PrEP’. We estimated median time to first PrEP discontinuation and examined factors associated with time to first PrEP discontinuation. Of 171 patients who received an initial 90-day PrEP prescription; 75% were assigned male at birth and 74% identified as Black. The median time to first discontinuation was 90 days (95% CI 90–114). Twenty-two percent were continuously on PrEP, 28% stopped and restarted (median time off PrEP = 102 days), and 50% stopped and did not restart. Associations with early PrEP stoppage were notable for patients assigned sex female vs male (adjusted hazard ratio [aHR] = 1.6, 95% CI 1.0–2.5) and those living over 25 miles from clinic vs. 0–10 miles (aHR 1.89, 95% CI 1.2–3.0). Most patients never refilled an initial PrEP prescription though many patients re-started PrEP. Interventions to improve persistence and facilitate re-starts are needed.

PrEP Acceptance among Eligible Patients Attending the Largest PrEP Clinic in Jackson, Mississippi

“…Indeed, a number of clinic-based PrEP programs in the US including in Mississippi have observed low persistence on PrEP, noting that 30-50% of individuals discontinue PrEP within the first 12 months of initiation. 20,25,[29][30][31][32][33][34] Additionally, it is important to recognize that over 50% of individuals newly diagnosed with HIV in Mississippi reside in rural communities, 35 and [CLINIC] is just one provider that is located in an urban area. Thus, continued efforts to increase PrEP awareness and education alongside interventions to improve PrEP persistence and implement same-day PrEP in settings outside large urban areas are needed to increase more widespread PrEP use Mississippi and elsewhere in the US.…”

Equity of PrEP uptake by race, ethnicity, sex and region in the United States in the first decade of PrEP: a population-based analysis

“…Here, we report trends in PrEP uptake overall and by US region, race and ethnicity, and sex in the US to describe overall changes in PrEP use in the first decade since PrEP regulatory approval. 10 , 11 , 12 , 13 , 14 , 15 , 16 We also present trends in race and ethnicity- and sex-specific PnRs using the PrEP Equity Ratio (PER) to characterise the extent to which PrEP use is equitable or inequitable.…”