From the Louisiana State University Health Sciences Center, New Orleans, LA.
Virginia Tech Carilion School of Medicine, Roanoke, VA.
Sex Transm Dis. 2021 Mar 1;48(3):183-188. doi: 10.1097/OLQ.0000000000001288.
Few studies have examined long-term outcomes among persons who initiate preexposure prophylaxis (PrEP) in the South, including PrEP discontinuation and sexually transmitted infection (STI) rates.
Care discontinuation (>6 months without a PrEP appointment) and incident STIs were evaluated for patients at 2 PrEP clinics in Durham, NC. We tested for predictors of discontinuation as a binary variable using logistic regression. Model covariates included age, race/ethnicity, sex, known HIV-positive partner, commercial sex work, men who have sex with men (MSM) versus not MSM, type of insurance, and clinic site. A similar analysis was completed for STI incidence, controlling for days in the study.
Among 271 patients, mean age was 33.2 years, 46.9% were Black and 11.1% were Latino, 81.2% were MSM, and 32% were uninsured. Preexposure prophylaxis was discontinued in 47%, and another 11% had intermittent care. Sexually transmitted infection incidence was 45.4/100 person-years, and 5 patients were diagnosed with HIV at baseline or in follow-up. Men who have sex with men were less likely to discontinue PrEP relative to non-MSM (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.10-0.64). Baseline STI was associated with a higher likelihood of incident STI (OR, 8.19; 95% CI, 3.69-19.21), whereas care discontinuation was associated with a lower likelihood of STI (OR, 0.28; 95% CI, 0.11-0.65).
Preexposure prophylaxis programs in the Southern United States are reaching uninsured and predominantly Black and Latino MSM, but discontinuation rates are high despite elevated rates of incident STI and HIV. Further work is required to elucidate causes of PrEP discontinuation and encourage persistence in care.
在南方，很少有研究检查开始暴露前预防（PrEP）的人（患者）的长期结果，包括 PrEP 停药和性传播感染（STI）的发生率。
在北卡罗来纳州达勒姆的 2 个 PrEP 诊所评估了患者的治疗中断（超过 6 个月没有 PrEP 预约）和新发 STI。我们使用逻辑回归检查了停药的预测因素（作为二项变量）。模型协变量包括年龄、种族/民族、性别、已知 HIV 阳性伴侣、商业性工作、男男性行为者（MSM）与非 MSM、保险类型和诊所地点。对 STI 发病率进行了类似的分析，控制了研究期间的天数。
在 271 名患者中，平均年龄为 33.2 岁，46.9%为黑人，11.1%为拉丁裔，81.2%为 MSM，32%为无保险者。PrEP 停药率为 47%，另有 11%的患者间断性接受治疗。性传播感染发病率为 45.4/100 人年，有 5 名患者在基线或随访时被诊断为 HIV。与非 MSM 相比，MSM 不太可能停止 PrEP（比值比[OR]，0.26；95%置信区间[CI]，0.10-0.64）。基线 STI 与新发 STI 的可能性增加相关（OR，8.19；95%CI，3.69-19.21），而治疗中断与 STI 的可能性降低相关（OR，0.28；95%CI，0.11-0.65）。
美国南部的 PrEP 项目正在为未参保且以黑人和拉丁裔 MSM 为主的人群提供服务，但尽管新发 STI 和 HIV 感染率较高，停药率仍很高。需要进一步研究阐明 PrEP 停药的原因，并鼓励患者坚持治疗。
