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J Acquir Immune Defic Syndr. 2019 Apr 11. doi: 10.1097/QAI.0000000000002054. [Epub ahead of print]

Predictors of Disengagement in Care for Individuals Receiving Pre-Exposure Prophylaxis (PrEP).

Author information

1
Fellow, Divisions of Infectious Diseases, Departments of Internal Medicine and Pediatrics Columbia University Medical Center, New York, NY, USAAssociate Professor, Division of Infectious Diseases, Department of Internal Medicine Columbia University Medical Center, New York, NY, USA.
2
Principal Investigator HIV Prevention Program, New York Presbyterian Hospital's Comprehensive Health Center, New York, NY, USA.
3
HIV Prevention Program, New York Presbyterian Hospital's Comprehensive Health Center, New York, NY, USA.
4
Data Program Manager, Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY, USA.
5
Fieldston school, New York, NY, USA.
6
Bowdoin College, Brunswick, ME, USA.
7
Research Assistant Professor, Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA.
8
Assistant Professor, Division of Infectious Diseases, Department of Internal Medicine Columbia University Medical Center, New York, NY, USAAssistant Professor, Division of Infectious Diseases, Department of Internal Medicine Columbia University Medical Center, New York, NY, USA.
9
Professor of Clinical Public Health & Clinical Pediatrics, Mailman School of Public Health & Columbia University Medical Center, New York, NY, USA.

Abstract

BACKGROUND:

HIV pre-exposure prophylaxis (PrEP) reduces incident HIV infections, but efficacy depends on adherence and retention, among other factors. Substance use disorders, un-met mental health needs, and demographic factors are associated with non-adherence in HIV-infected patients; we studied whether these affect PrEP loss-to-follow-up.

METHODS:

To investigate potential risk factors for non-adherence with PrEP and loss-to-follow-up in a comprehensive HIV prevention program, we conducted a retrospective cohort analysis of individuals starting tenofovir-emtricitabine between 1/1/2015 and 11/30/2017. The primary outcome was adherence to the initial three visit schedule after PrEP initiation.

RESULTS:

The cohort was predominantly Black (23%) and Hispanic (46%). Race, ethnicity, substance use, patient health questionnaire 9 score, insurance, and housing status were not associated with retention at the third follow-up visit. Age < 30, PrEP initiation in 2017, PrEP initiation in the sexual health clinic, and PrEP same-day start were associated with lower retention; Male gender at birth, transition from PEP to PrEP, feeling that they could benefit from, or participating in mental health services were associated with increased retention. Overall, retention in HIV preventative care at the first follow-up visit (68%) and third follow-up visit (35%) after PrEP initiation was low.

CONCLUSION:

Clinic services and ancillary services (like mental health) may facilitate retention in care. In this study select social and behavioral determinants of health were not found to be linked to retention. Focused investigation of reasons for dropout may elucidate the challenges to maintaining individuals in PrEP care and direct resource allocation to those in greatest need.

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