Secondary Logo

Institutional members access full text with Ovid®

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

Zucker, Jason, MD, MS1; Carnevale, Caroline, FNP, MPH, AAHIVS2; Richards, Paul, MPH3; Slowikowski, Jacek, MPH4; Borsa, Alexander, PrEP Navigator3; Gottlieb, Felix5; Vakkur, Isabella6; Hyden, Christel, Ed.D.7; Olender, Susan, MD, MS8; Cohall, Alwyn, MD9; Gordon, Peter, MD8; Sobieszczyk, Magdalena E., MD, MPH10

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 11, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002054
Original Article: PDF Only
Buy
PAP

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.

1Fellow, Divisions of Infectious Diseases, Departments of Internal Medicine and Pediatrics Columbia University Medical Center, New York, NY, USA

2Principal Investigator HIV Prevention Program, New York Presbyterian Hospital’s Comprehensive Health Center, New York, NY, USA

3HIV Prevention Program, New York Presbyterian Hospital’s Comprehensive Health Center, New York, NY, USA

4Data Program Manager, Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY, USA

5Fieldston school, New York, NY, USA

6Bowdoin College, Brunswick, ME, USA

7Research Assistant Professor, Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA

8Assistant Professor, Division of Infectious Diseases, Department of Internal Medicine Columbia University Medical Center, New York, NY, USA

9Professor of Clinical Public Health & Clinical Pediatrics, Mailman School of Public Health & Columbia University Medical Center, New York, NY, USA

8Assistant Professor, Division of Infectious Diseases, Department of Internal Medicine Columbia University Medical Center, New York, NY, USA

10Associate Professor, Division of Infectious Diseases, Department of Internal Medicine Columbia University Medical Center, New York, NY, USA

Corresponding Author: Jason Zucker, MD MS 622 West 168th Street 8th Floor New York, NY 10032 Jz2700@cumc.columbia.edu 201-723-6637

The authors report no conflicts of interest related to this work.

Sources of Support: Dr. Zucker is supported by the training grant “Training in Pediatric Infectious Diseases” (National Institute of Allergy and Infectious Diseases T32AI007531) and the New York STD Prevention Training Center (Centers for Disease Control - RFA-PS14-1407).

This project was funded in part by the New York City Department of Health and Mental Hygiene through a contract with Public Health Solutions. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the funders

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.