SEATTLE — Women and young patients are less likely to persistently use pre-exposure prophylaxis, or PrEP, for HIV prevention compared with men and older users, according to study data presented at CROI.
“In the Unites States, less than 10% of persons who would benefit from PrEP initiate it. For those who have started, some stop using it while at risk and become susceptible to HIV infection,” CDC researcher Ya-Lin A. Huang, PhD, MS, said during a news conference. “PrEP can reduce HIV incidence and help end the HIV epidemic; however, it requires persistent use during periods of risk to be effective.”
Huang clarified that persistence and adherence vary in definition. Adherence, she said, is the degree to which a person takes a drug or prescription as advised by their provider, whereas persistence is the length of use from initiation to discontinuation without disruption of longer than 30 days.
In their study, which used data from the IBM MarketScan Research Databases, Huang and colleagues focused on persistence and the contributing characteristics of it in a cohort of patients aged 18 to 64 years who initiated PrEP in the years 2012 to 2016. They deemed participants nonpersistent if they did not refill their prescription within 30 days after exhausting PrEP medications from a previous fill.
Of the 7,250 commercially insured PrEP users included in the study, 74.8% persisted for 6 months and 55.7% for 12 months, with female, young and rural residents being less likely to be persistent, according to adjusted estimates, Huang and colleagues reported. The median persistence was 14.5 months (95% CI, 13.9-15) but was significantly shorter for female PrEP users (6.9 months; 95% CI, 4.7-11.6) and for users aged 18 to 24 years (8.6 months; 95% CI, 7.4-9.3).
Huang said PrEP persistence is poorly understood and “would benefit from additional research to assess reasons for discontinuation and how these reasons associate with patient characteristics.”
A better understanding of PrEP persistence will help inform the design of programs and interventions to help overcome these challenges,” Huang said. “All in all, our study provides insight on PrEP use patterns and various groups. Our study findings underscore the need for interventions, specifically for priority populations, to support PrEP persistence.”– by Caitlyn Stulpin
Huang YA, et al. Abstract 84LB. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.
Even when people have insurance, we find that if you are older, it is easier to persist with PrEP; if you are a man, it is easier to persist with PrEP; if you are white, it is easier to persist with PrEP. So, at the end of the day, we have this complete mismatch between who is at greatest risk for having HIV and who actually persists with PrEP. The people who probably have less likelihood for having HIV are doing better at taking prevention than those with higher likelihood and so we need to do better, understand better how to connect people with prevention behavior that feels right to them. Healthy people, for example, do not like taking drugs every day, especially young healthy people who want to have sex and enjoy themselves and do not want to medicalize it. I think that the real lesson is that even though people know in their heart that PrEP might reduce their risk, that they cannot stick with it. So, what can we do to reach into those populations so they can internalize it to use it as a prevention strategy for their lives? I do not think we know the answer to that. What we are doing right now is describing what is happening, but I challenge people to really think hard about how we change that.
Sharon Hillier, PhD
Professor of reproductive infectious diseases
University of Pittsburgh School of Medicine