Jason Zucker1, Caroline Carnevale2, Paul Richards2, Jacek Slowikowski3, Alexander Borsa2, Felix Gottlieb4, Isabella Vakkur5, Christel Hyden6, Susan Olender7, Alwyn Cohall8, Peter Gordon7, Magdalena E Sobieszczyk7. 1. Divisions of Infectious Diseases, Departments of Internal Medicine and Pediatrics, Columbia University Irving Medical Center, New York, NY. 2. HIV Prevention Program, New York Presbyterian Hospital's Comprehensive Health Center, New York, NY. 3. Comprehensive Health Program (CHP), New York Presbyterian Hospital, New York, NY. 4. Fieldston School, New York, NY. 5. Bowdoin College, Brunswick, ME. 6. Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY. 7. Division of Infectious Diseases, Department of Internal Medicine, Columbia University Medical Center, New York, NY. 8. Sociomedical Sciences, Population and Family Health, and Pediatrics, Mailman School of Public Health and Columbia University Medical Center, New York, NY.
Abstract
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) reduces incident HIV infections, but efficacy depends on adherence and retention, among other factors. Substance use disorders, unmet mental health needs, and demographic factors are associated with nonadherence in HIV-infected patients; we studied whether these affect PrEP retention in care. METHODS: To investigate potential risk factors disengagement in a comprehensive HIV prevention program, we conducted a retrospective cohort analysis of individuals starting tenofovir-emtricitabine between January 1, 2015, and November 30, 2017. The primary outcome was adherence to the initial 3-visit schedule after PrEP initiation. RESULTS: The cohort was predominantly African American (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 post-exposure prophylaxis (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 (such as 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.
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) reduces incident HIV infections, but efficacy depends on adherence and retention, among other factors. Substance use disorders, unmet mental health needs, and demographic factors are associated with nonadherence in HIV-infectedpatients; we studied whether these affect PrEP retention in care. METHODS: To investigate potential risk factors disengagement in a comprehensive HIV prevention program, we conducted a retrospective cohort analysis of individuals starting tenofovir-emtricitabine between January 1, 2015, and November 30, 2017. The primary outcome was adherence to the initial 3-visit schedule after PrEP initiation. RESULTS: The cohort was predominantly African American (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 post-exposure prophylaxis (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 (such as 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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