Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA.
Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA.
Pharmacoepidemiol Drug Saf. 2024 Jan;33(1):e5729. doi: 10.1002/pds.5729. Epub 2023 Nov 20.
To describe medication adherence and persistence of HIV PrEP overall and compare between sex and age groups of commercially insured individuals in the United States.
We conducted a national retrospective cohort study of the Merative MarketScan Claims Database from 2011 to 2019 to describe adherence and persistence of PrEP overall and compared between sex and age groups. High adherence was defined as ≥80% of proportion of days covered and persistence was measured in days from initiation to the first day of a 60-day treatment gap.
A total of 29 689 new PrEP users identified. Overall adherence was high (81.9%; 95% confidence interval [CI]: 81.5%-82.3%). Females were more adherent than males (adjusted odds ratio [aOR] 1.87; 95% CI: 1.50-2.34), while those ≥45-years were less adherent than individuals <45-years (aOR 0.87: 95% CI: 0.81-0.93). More than half of individuals discontinued therapy within the first year (median 238.0 days; interquartile range 99.0-507.0 days). Females were less persistent than males (hazard ratio [HR] 1.49; 95% CI: 1.34-1.65), and people ≥45-years old were more persistent (i.e., lower risk of discontinuation) than those <45-years (HR 0.43; 95% CI: 0.33-0.55).
These findings show adherence to daily PrEP is high among commercially insured individuals but the majority still discontinue in the first year. Future research should investigate what factors influence PrEP discontinuation among this population and ways to reduce barriers to therapy maintenance to ensure the population-level benefits of PrEP treatment.
描述美国商业保险个体中总体上的 HIV 暴露前预防（PrEP）用药依从性和持久性，并比较不同性别和年龄组间的差异。
我们对 2011 年至 2019 年 Merative MarketScan 理赔数据库进行了一项全国性回顾性队列研究，描述了总体上 PrEP 的用药依从性和持久性，并比较了不同性别和年龄组间的差异。高依从性定义为≥80%的用药比例天数覆盖，持久性则通过从起始日到首次出现 60 天治疗中断的天数来衡量。
共确定了 29689 名新的 PrEP 用户。总体上，依从性较高（81.9%；95%置信区间[CI]：81.5%-82.3%）。女性比男性更依从（调整后优势比[aOR] 1.87；95%CI：1.50-2.34），而≥45 岁者比<45 岁者更不依从（aOR 0.87；95%CI：0.81-0.93）。超过一半的个体在第一年就停止了治疗（中位数 238.0 天；四分位距 99.0-507.0 天）。女性比男性更不持久（风险比[HR] 1.49；95%CI：1.34-1.65），而≥45 岁者比<45 岁者更持久（即，停药风险更低）（HR 0.43；95%CI：0.33-0.55）。
这些发现表明，商业保险个体中每日 PrEP 的依从性较高，但大多数个体仍在第一年停药。未来的研究应调查哪些因素影响该人群中 PrEP 的停药，并探索减少治疗维持障碍的方法，以确保 PrEP 治疗的人群获益。
