aBridge HIV, San Francisco Department of Public Health bDepartment of Epidemiology and Biostatistics, University of California, San Francisco cUniversity of California, San Francisco dNational Clinician Scholars Program at University of California, Los Angeles eSan Francisco Department of Public Health fDepartment of Medicine, University of California, San Francisco, San Francisco, California, USA.
AIDS. 2019 Nov 15;33(14):2189-2195. doi: 10.1097/QAD.0000000000002347.
Dissemination of preexposure prophylaxis (PrEP) is a priority for reducing new HIV infections, especially among vulnerable populations. However, there are limited data available on PrEP discontinuation following initiation, an important component of the PrEP cascade.
Patients receiving PrEP within the San Francisco Department of Public Health Primary Care Clinics (SFPCC) are included in a PrEP registry if they received a PrEP prescription, were not receiving postexposure prophylaxis, and not known to be HIV-positive.
We calculated PrEP discontinuation for patients initiating PrEP at any time from January 2012 to July 2017 and evaluated their association with demographic and risk variables using Cox regression analysis.
Overall, 348 patients received PrEP over the evaluation period. The majority (84%) were men, and the cohort was racially/ethnically diverse. The median duration of PrEP use was 8.3 months. In adjusted analysis, PrEP discontinuation was lower among older patients (aHR 0.89; 95% CI 0.80-0.99; P = 0.03); but higher among black patients (compared with white patients; aHR 1.87; 95% CI 1.27-2.74; P = 0.001), patients who inject drugs (aHR 4.80; 95% CI 2.66-8.67; P < 0.001), and transgender women who have sex with men (compared with MSM; aHR 1.94; 95% CI 1.36-2.77; P < 0.001).
Age, racial/ethnic, and risk category disparities in PrEP discontinuation were identified among patients in a public health-funded primary care setting. Further efforts are needed to understand and address PrEP discontinuation among priority populations to maximize the preventive impact of PrEP, and reverse HIV-related disparities at a population level.
推广暴露前预防（PrEP）是减少新的 HIV 感染的重点，尤其是在弱势群体中。然而，关于起始后 PrEP 停药的数据有限，而这是 PrEP 级联的一个重要组成部分。
在旧金山公共卫生部初级保健诊所（SFPCC）接受 PrEP 的患者，如果他们接受了 PrEP 处方、未接受暴露后预防且 HIV 检测结果未知，则被纳入 PrEP 登记处。
我们计算了 2012 年 1 月至 2017 年 7 月期间任何时间开始接受 PrEP 的患者的 PrEP 停药率，并使用 Cox 回归分析评估了他们与人口统计学和风险变量的相关性。
总体而言，348 名患者在评估期间接受了 PrEP。大多数（84%）为男性，队列种族/民族多样化。PrEP 使用的中位持续时间为 8.3 个月。在调整分析中，年龄较大的患者（aHR 0.89；95%CI 0.80-0.99；P=0.03）的 PrEP 停药率较低；但黑人患者（与白人患者相比；aHR 1.87；95%CI 1.27-2.74；P=0.001）、注射毒品的患者（与男性同性性行为者相比；aHR 4.80；95%CI 2.66-8.67；P<0.001）和与男性发生性关系的跨性别女性（与 MSM 相比；aHR 1.94；95%CI 1.36-2.77；P<0.001）的 PrEP 停药率较高。
在公共卫生资助的初级保健环境中，患者的 PrEP 停药率存在年龄、种族/民族和风险类别的差异。需要进一步努力了解和解决重点人群的 PrEP 停药问题，以最大限度地发挥 PrEP 的预防作用，并在人群层面扭转与 HIV 相关的差异。
