Article Text

Download PDFPDF
Determinants of pre-exposure prophylaxis (PrEP) persistence in a high-risk population in Central Florida
  1. Jonathan Keyes1,
  2. Eloisa Catherine Crouse1,
  3. Edwin DeJesus1,
  4. Charlotte-Paige Rolle2
  1. 1 Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
  2. 2 Clinical Research, Emory University School of Public Health, Atlanta, Georgia, USA
  1. Correspondence to Dr Charlotte-Paige Rolle, Emory University School of Public Health, Atlanta, GA 30322, USA; crolle{at}oicorlando.com

Abstract

Orlando has the second highest HIV incidence in the USA. Tenofovir disoproxil fumarate/emtricitabine is approved as pre-exposure prophylaxis (PrEP) to minimize HIV transmission. Our study describes the PrEP care continuum and factors impacting PrEP persistence during the first year of PrEP care at a sexual health clinic in Orlando. Patients initiating PrEP between 2014 and 2017 with at least 1 year of follow-up were eligible for inclusion. Demographic and clinical factors were extracted from medical records. At the end of the first year of PrEP care, patients seen within the last 6 months were defined as ‘persistent’ whereas patients lost to follow-up for ≥6 months were defined as ‘not persistent’. We evaluated factors associated with PrEP persistence with Firth’s multivariable logistic regression. Of 300 patients meeting inclusion criteria, 96% were male, 59% were ≥30 years old, 59% identified as men who have sex with men and 57% endorsed recent condomless anal intercourse. Of PrEP initiators, 133 (44.3%) were persistent in the first year, whereas 167 (55.7%) were not persistent. PrEP persistence was positively associated with age ≥30 years (OR 1.04, 95% CI 1.0 to 1.08) and negatively associated with non-white race (OR 0.33, 95% CI 0.12 to 0.83). There were no HIV seroconversions among persistent patients. In our study, younger and minority patients were less likely to persist in PrEP care and persistence was poor despite many being insured and ‘high-risk’. Further research is needed to identify and address barriers that hinder PrEP persistence, specifically among younger, minority patients.

  • antiviral agents
  • community health services
  • immunosuppression

Statistics from Altmetric.com

Footnotes

  • Contributors All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline. To the best of our knowledge, no conflict of interest, financial or other, exists. We have included acknowledgments, conflicts of interest and funding sources in the manuscript file. Each author’s specific contribution is noted below. JK: gathered, analyzed and interpreted the data necessary for the writing of this article, drafted and heavily revised the paper, provided the final review for the approval of submission and has agreed to be fully accountable of the work ensuring its accuracy and integrity. ECC: assisted in the interpretation of the data necessary for the writing of this article, drafted and heavily revised the paper, provided the final review for the approval of submission and has agreed to be fully accountable of the work ensuring its accuracy and integrity. EDJ: responsible for the conception and design of the study, assisted in revision of the article, provided the final review for the approval of submission and has agreed to be fully accountable of the work ensuring its accuracy and integrity. C-PR: responsible for the conception and design of the study, critically revised the article, provided the final review for the approval of submission and has agreed to be fully accountable of the work ensuring its accuracy and integrity.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The University of Central Florida College of Medicine Institutional Review Board (IRB) determined that this study met IRB exemption criteria based on the utilization of retrospective data that were collected as a part of routine clinical care.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.