Format

Send to

Choose Destination
AIDS Behav. 2019 Apr 5. doi: 10.1007/s10461-019-02493-w. [Epub ahead of print]

Mind the gaps: prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California : Mind the Gaps: Cobertura de recetas e incidencia de VIH entre pacientes recibiendo profilaxis pre-exposición de un centro de salud grande y federalmente calificado en Los Ángeles, CA.

Author information

1
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA. clshover@stanford.edu.
2
Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA. clshover@stanford.edu.
3
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA. clshover@stanford.edu.
4
Departments of Family Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
5
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
6
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
7
Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA.
8
Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
9
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

Abstract

We conducted a records-based cohort study of patients who initiated pre-exposure prophylaxis (PrEP) at a large federally qualified health center in Los Angeles, CA to characterize patterns of PrEP use, identify correlates of PrEP discontinuation, and calculate HIV incidence. Of 3121 individuals initiating PrEP between 2014 and 2017, 42% (n = 1314) were active (i.e., had a current PrEP prescription) in April 2018. HIV incidence was 0.1/100 person-years among active PrEP patients, compared to 2.1/100 person-years among patients who discontinued. Compared to patients accessing PrEP through government programs with no prescription copay, risk of discontinuation was higher among those with private insurance (ARR = 1.4, 95% CI 1.2, 1.7), or no insurance (ARR = 4.5, 95% CI 3.2, 6.4). Sixty-three percent of active PrEP patients had gaps between PrEP prescriptions, averaging one gap per year (median length = 65 days). Increasing access to free or low-cost PrEP can improve PrEP continuity.

KEYWORDS:

HIV incidence; HIV prevention; Health insurance; Pre-exposure prophylaxis

PMID:
30953305
DOI:
10.1007/s10461-019-02493-w

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center