Timely pre-exposure prophylaxis (PrEP) initiation is critical in at-risk populations, given that HIV acquisition risk persists during delays. Time to treatment initiation, a key metric in HIV care, has not been explored among PrEP users. Interventions that reduce time to PrEP initiation could prevent HIV infections.
Individuals initiating PrEP in a large primary care health network of 15 clinics, the San Francisco Primary Care Clinics (SFPCC), from July 2012 to July 2017 (N = 411).
We examined factors associated with time from first PrEP discussion with a provider to PrEP initiation date using an adjusted Cox proportional-hazards model, with hazard ratios (HRs) >1 indicating earlier initiation. We also examined the relationship between delayed PrEP initiation and PrEP persistence (staying on PrEP) in an adjusted Cox proportional-hazards model.
PrEP users initiated PrEP after a median of only 7 days. However, there were notable outliers, with 29% waiting >30 days and 12% waiting >90 days. In an adjusted proportional-hazards model, a panel management and patient navigation intervention was associated with earlier PrEP initiation [HR: 1.5; 95% confidence interval (CI): 1.1 to 2.0], whereas only other race/ethnicity compared with white race was associated with delayed PrEP initiation (HR: 0.7; 95% CI: 0.5 to 1.0). Delayed PrEP initiation >30 days was associated with shorter PrEP persistence in an adjusted proportional-hazards model (HR: 1.3; 95% CI: 1.0 to 1.7).
PrEP initiation within a week is feasible in a primary care safety-net health system. Setting a goal of rapid PrEP initiation, with the support of panel management and patient navigation, could address delays in at-risk groups.
*Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, CA;
†Bridge HIV, San Francisco Department of Public Health, San Francisco, CA; and
Departments of ‡Epidemiology and Biostatistics;
§Medicine, University of California, San Francisco, San Francisco, CA.
Correspondence to: Matthew A. Spinelli, MD, Division of HIV, ID, and Global Medicine, University of California, San Francisco, 25 Van Ness Avenue, Suite 100, San Francisco, CA 94102 (e-mail: Matthew.Spinelli@UCSF.edu).
Supported by the National Institute of Mental Health at the National Institute of Health (R01MH109320).
A.Y.L. has led studies in which Gilead Sciences has donated study drug. The remaining authors have no funding or conflicts of interest to disclose.
Received April 26, 2018
Accepted July 16, 2018