The importance of PrEP persistence in preventing HIV infections on PrEP

Spinelli, Matthew A; Laborde, Nicole; Kinley, Patrick M.; Whitacre, Ryan; Scott, Hyman; Walker, Nicole; Liu, Albert Y.; Gandhi, Monica; Buchbinder, Susan

doi:10.1002/jia2.25578

Cited by 4 publications

(4 citation statements)

References 10 publications

(10 reference statements)

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“…Low self-perceived risk, younger age, and cannabis use also predicted discontinuation. 18 Similar to other recent findings, our analysis shows the modest likely impact of LAI compared with its relatively high cost. 12 Policies regarding drug prices are now under discussion at the federal level, so the situation may change.…”

Section: Discussionsupporting

confidence: 91%

“…17 Although PrEP users reported high levels of adherence to daily dosing schedules there is also data that PrEP users discontinue or cycle on and off PrEP use over longer periods. 18 To capture the variation in an individual's PrEP use over time, we created a unique measure for each participant's "consistent use" that documented whether "current PrEP use" was reported continuously for at least 5 times of 7 data points (0, 4, 8, 12, 16, 20, and 24 months) over the 2 years. In summary, measures "current PrEP use" and "adherence" were time-variant and could vary at each visit (see A-2 A1 Appendices A-1 and A-2, Supplemental Digital Content, http://links.lww.com/QAI/C107), whereas "consistent use" was defined for the entire study period.…”

Section: Prep Adherencementioning

confidence: 99%

See 1 more Smart Citation

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

Aryal,

A Leibowitz,

Comulada

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: Expanding HIV pre-exposure prophylaxis (PrEP) use is key to goals for lowering new HIV infections in the U.S. by 90% between 2022 and 2030. Unfortunately, youth aged 16–24 have the lowest PrEP use of any age group and the highest HIV incidence rates. Methods: To examine the relationship between HIV seroconversion and PrEP uptake, adherence, and continuity, we used survival analysis and multivariable logistic regression on data of 895 youth at-risk for HIV infection enrolled in Adolescent Trials Network for HIV Medicine protocol 149 in Los Angeles and New Orleans, assessed at 4-month intervals over 24 months. Results: The sample was diverse in race/ethnicity (40% Black, 28% Latine, 20% White). Most participants (79%) were cis-gender gay/bisexual male but also included 7% transgender female and 14% trans masculine and nonbinary youth. Self-reported weekly PrEP adherence was high (98%). Twenty-seven participants acquired HIV during the study. HIV incidence among PrEP users (3.12 per 100 person year [PY]) was higher than those who never used PrEP (2.53/100 PY). The seroconversion incidence was highest among PrEP users with discontinuous use (3.36/100 PY). If oral PrEP users were adherent using 2-monthly long-acting injectables, our estimate suggests 2.06 infections per 100 PY could be averted. Conclusions: Discontinuous use of PrEP may increase risk of HIV acquisition among youth at higher risk for HIV infection and indications for PrEP. Thus, to realize the promise of PrEP in reducing new HIV infections, reducing clinical burdens for PrEP continuation are warranted.

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Section: Discussionsupporting

confidence: 91%

Section: Prep Adherencementioning

confidence: 99%

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

Aryal,

A Leibowitz,

Comulada

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

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“…PrEP uptake is an important component of combination prevention and is a critical factor toward global targets of reducing HIV infection or transmission. [25] In addition, PrEP is a very effective and ethical method used to prevent HIV infections with its efficacy dependent upon adherence. [26] Progress has been made over the years in interventions (for instance PrEP) to help prevent the infection of HIV globally.…”

Section: Discussionmentioning

confidence: 99%

Willingness to take and ever use of pre-exposure prophylaxis among female sex workers in Ghana

Guure¹,

Afagbedzi²,

Torpey

2022

Medicine

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Pre-exposure prophylaxis (PrEP) is a drug taken by people who are human immunodeficiency virus (HIV) negative and at increased risk of acquiring HIV. It's an effective intervention for HIV prevention. This study seeks to report on the prevalence and determinants of willingness to take and ever use of PrEP among female sex workers (FSW) in Ghana.The data analyzed was obtained from the Integrated Bio-behavioral Surveillance Survey conducted across the 16 regions of Ghana in 2020. Analysis was only performed on FSW who were tested negative to HIV and were sexually active. All included variables were described using medians, percentages, and graphs. Bayesian adjusted odds ratios and 95% credible intervals were estimated using a Bayesian generalized linear model via the binomial family of distributions under the logit link function.Of the 5107 FSW with complete data on willingness to use PrEP, 2737 (53.59%) reported their willingness to take PrEP. Out of the 998 respondents who have ever heard of PrEP only 64 (6.39%) have ever used PrEP. The median age of the respondents was 25 years. People with no comprehensive knowledge of HIV and acquired immunodeficiency syndrome as well as those who entered into the FSW business at age less than 25 years; 946 (34.56%) and 2181 (79.65%) respectively were more willing to take PrEP. FSW from 6 out of the 16 regions of Ghana have never used PrEP. A statistically significant difference between those who entered the sex work at age less than 25 years and those within 25 to 34 years was observed. About 23% of FSWs who had been screened for Sexually Transmitted Infections were more likely to take PrEP.Respondents with lesser age and no comprehensive knowledge of HIV were more willing to take PrEP. The willingness to accept PrEP among FSWs in Ghana is modest. However, utilization is low. Advocacy or intervention programs are required to improve uptake of PrEP.

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“…1 HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among MSM when taken as a daily pill, on-demand pill before and after a sexual encounter, or bimonthly injection. [2][3][4] However, there are significant challenges in achieving high levels of persistence, or the ability of patients to continue to take PrEP for as long as they would like, 5 with many MSM discontinuing after short periods of use despite ongoing risk for infection. 6 Most recently, the coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide and disrupted typical access to health care.…”

Section: Introductionmentioning

confidence: 99%

Pre-exposure Prophylaxis Discontinuation During the COVID-19 Pandemic Among Men Who Have Sex With Men in a Multisite Clinical Cohort in the United States

Goedel

Rogers

Liu

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:The coronavirus disease 2019 (COVID-19) pandemic continues to put strain on health systems in the United States, leading to significant shifts in the delivery of routine clinical services, including those offering HIV pre-exposure prophylaxis (PrEP). We aimed to assess whether individuals discontinued PrEP use at higher rates during the COVID-19 pandemic and the extent to which disruptions to usual clinical care were mitigated through telehealth.Methods:Using data from an ongoing prospective cohort of men who have sex with men (MSM) newly initiating PrEP in 3 mid-sized cities (n = 195), we calculated the rate of first-time discontinuation of PrEP use in the period before the COVID-19 pandemic and during the COVID-19 pandemic and compared these rates using incidence rate ratios (IRRs). Furthermore, we compared the characteristics of patients who discontinued PrEP use during these periods with those who continued to use PrEP during both periods.Results:Rates of PrEP discontinuation before the COVID pandemic and during the COVID-19 pandemic were comparable [4.29 vs. 5.20 discontinuations per 100 person-months; IRR: 1.95; 95% confidence interval (CI): 0.83 to 1.77]. Although no significant differences in the PrEP discontinuation rate were observed in the overall population, the rate of PrEP discontinuation increased by almost 3-fold among participants aged 18–24 year old (IRR: 2.78; 95% CI: 1.48 to 5.23) and by 29% among participants covered by public insurance plans at enrollment (IRR: 1.29; 95% CI: 1.03 to 5.09). Those who continued to use PrEP were more likely to have had a follow-up clinical visit by telehealth in the early months of the pandemic (45% vs. 17%).Conclusions:In this study, rates of PrEP discontinuation were largely unchanged with the onset of the COVID-19 pandemic. The use of telehealth likely helped retain patients in PrEP care and should continue to be offered in the future.

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The importance of PrEP persistence in preventing HIV infections on PrEP

Cited by 4 publications

References 10 publications

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

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

Willingness to take and ever use of pre-exposure prophylaxis among female sex workers in Ghana

Pre-exposure Prophylaxis Discontinuation During the COVID-19 Pandemic Among Men Who Have Sex With Men in a Multisite Clinical Cohort in the United States

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