Persistence on HIV preexposure prophylaxis medication over a 2‐year period among a national sample of 7148 PrEP users, United States, 2015 to 2017

Abstract

Introduction Persistence on preexposure prophylaxis for HIV prevention (PrEP) medication has rarely been reported for periods greater than one year, or in real‐world settings. This study used pharmacy fill records for PrEP users from a national chain pharmacy to describe persistence on PrEP medication over a two‐year period, and to explore correlates with PrEP medication persistence in a real‐world setting. Methods We analysed de‐identified pharmacy fill records of 7148 eligible individuals who initiated PrEP in 2015 at a national chain pharmacy. A standard algorithm was employed to identify TDF‐FTC use for PrEP indication. We considered three time periods for persistence, defined as maintaining refills in PrEP care: year 1 (zero to twelve months), year 2 (thirteen to twenty‐four months) and initiation to year 2 (zero to twenty‐four months). Individuals with 16 or more days of TDF‐FTC PrEP dispensed in a 1‐month period for at least three‐quarters of a given time period (e.g. nine of twelve months or eighteen of twenty‐four months) were classified as persistent on PrEP medication for the period. Results Persistence was 56% in year 1, 63% in year 2 and 41% from initiation to year 2. Individuals aged 18 to 24 had the lowest persistence, with 29% from initiation to year 2. Men had higher persistence than women, with 42% compared to 20% persistent from initiation to year 2. Individuals with commercial insurance and individuals who utilized a community‐based specialty pharmacy from the national chain also had higher persistence. Male gender, age >18 to 24 years, average monthly copay of $20 or less, commercial insurance, and utilization of a community‐based specialty pharmacy were positively associated in adjusted models with persistence in year 1 and from initiation to year 2; the same correlates, with the exception of utilization of a community‐based specialty pharmacy, were associated with higher persistence in year 2. Conclusions We found substantial non‐persistence on PrEP medication in both year 1 and year 2. Across the entire 2‐year period, only two out of every five users persisted on PrEP. Demographic, financial and pharmacy factors were associated with persistence. Further research is needed to explore how social, structural or individual factors may undermine or enhance persistence on PrEP, and to develop interventions to assist persistence on PrEP.

Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care

“…We speculate competing needs faced by individuals with low incomes impact engagement in ongoing care. Both real and perceived costs directly related to PrEP care have been shown to negatively impact retention [30, 31], but more research is needed to elucidate which barriers continue to impact low income individuals’ engagement in ongoing PrEP care after out-of-pocket costs are covered.…”

Give PrEP a chance: moving on from the “risk compensation” concept

“…Building individual capacity to evaluate personal risk, and thus, empower PrEP users to find prevention strategies that meet their needs for a satisfying sexual life, can potentially have lasting effects, regardless of the duration of PrEP use. Although limited, longitudinal data on PrEP use has shown important decreases in retention over time . Changes in sexual behaviours, perceived HIV risk, financial cost, adverse effects and problems related to adherence have been identified as reasons for PrEP discontinuation .…”

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

“…A study of 7148 individuals who initiated PrEP at a national chain pharmacy in the USA reported only 56% persistence in year 1, 63% in year 2, and 41% from initiation to year 2, with the lowest persistence in women and individuals aged 18--24 years. Factors predicted to contribute to PrEP cessation included financial barriers, changes in perceived risk, and difficulties accessing healthcare services [99]. Overcoming barriers to PrEP uptake may therefore have a concurrent positive impact on adherence to PrEP.…”