Department of Epidemiology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA, 98104, USA.
University of Mississippi Medical Center, Jackson, MS, USA.
AIDS Behav. 2023 Apr;27(4):1082-1090. doi: 10.1007/s10461-022-03845-9. Epub 2022 Sep 12.
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.
暴露前预防（PrEP）的持续使用在美国并不理想。在新 HIV 诊断率较高的美国南部腹地，PrEP 停药模式仍未得到探索。我们评估了密西西比州杰克逊市一个基于诊所的 PrEP 项目的数据，纳入了 2018 年 8 月至 2021 年 4 月期间开始接受 PrEP 的患者。如果患者至少有 30 天没有有效的 PrEP 处方，我们认为他们的 PrEP 覆盖存在缺口；如果在 30 天后重新开始 PrEP，则将其归类为“停止后重新开始”，而从未获得新的 PrEP 处方的患者则归类为“停止后未重新开始”。没有 PrEP 覆盖缺口的患者被认为是“持续接受 PrEP”。我们估计了首次 PrEP 停药的中位时间，并检查了与首次 PrEP 停药时间相关的因素。在接受初始 90 天 PrEP 处方的 171 名患者中，75%为出生时男性，74%为黑人。首次停药的中位时间为 90 天（95%CI 90-114）。22%的患者持续接受 PrEP，28%的患者停止并重新开始（停止 PrEP 中位数时间=102 天），50%的患者停止并未重新开始。与早期 PrEP 停药相关的因素包括：分配给女性的患者（调整后的危险比[aHR]1.6，95%CI 1.0-2.5）和距离诊所超过 25 英里的患者（aHR 1.89，95%CI 1.2-3.0）。尽管许多患者重新开始接受 PrEP，但大多数患者从未重新开处初始 PrEP 处方。需要采取干预措施以提高持续性并促进重新开始。
