Missed Visits Associated With Future Preexposure Prophylaxis (PrEP) Discontinuation Among PrEP Users in a Municipal Primary Care Health Network. (26th February 2019)

• Record Type: Journal Article
• Authors: Spinelli, Matthew A; Scott, Hyman M; Vittinghoff, Eric; Liu, Albert Y; Gonzalez, Rafael; Morehead-Gee, Alicia; Gandhi, Monica; Buchbinder, Susan P
• Is Part Of: Open forum infectious diseases. Volume 6:Number 4(2019)
• Publication Date: 2019-02-26
• Subjects: preexposure prophylaxis -- PrEP persistence -- retention in care -- missed visits -- primary care; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofz101
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Maintaining retention in preexposure prophylaxis (PrEP) care among diverse patient populations will be needed to support PrEP's efficacy. We characterized patterns of PrEP care retention in a US municipal primary care health network and examined whether missed visits, a metric of care retention that is easy to evaluate in clinic, are associated with subsequent discontinuation. Methods: We included individuals on PrEP from July 2012 until August 2017 in the San Francisco Primary Care Clinics, a 15-clinic municipal health network. We categorized PrEP usage patterns as follows: early discontinuation (<90 days), later discontinuation (after ≥90 days), and continuing use at the end of follow-up. We first examined early discontinuation using adjusted Poisson regression. In patients who continued PrEP for ≥90 days, we examined factors associated with late discontinuation. Results: Of the 364 individuals who started PrEP, 16% discontinued PrEP before 90 days, 46% discontinued later, and 38% were retained in care over a median 12 months of observation. Transgender women were more likely to discontinue PrEP early (adjusted risk ratio; 2.16; 95% confidence interval, 1.36–3.49), and younger users were more likely to discontinue late (0.82 per 10-year increase in age; .70–.96), as were persons who use illicit drugs (1.59; 1.02–2.47). Missed visits during use of PrEP were associated with future discontinuation (adjusted risk ratio, 1.52; 95% confidence interval, 1.14–2.03). Later year of current PrEP use was associated with both early and late discontinuation. Conclusion: Diverse populations may require differentiated care to continue PrEP. Missed visits should trigger tailored interventions to maximize the impact of PrEP. Abstract : Preexposure prophylaxis (PrEP) users in primary care continued PrEP for a median of 8 months. Transgender women experienced higher risk of early discontinuation; younger users experienced late discontinuation. Missed visits during PrEP are associated with discontinuation and should trigger outreach.