Zoe D Unger1, Sarit A Golub1,2,3, Christine Borges4, Zoe R Edelstein5, Trevor Hedberg4,6, Julie Myers5,7. 1. Department of Psychology, Hunter College, City University of New York, New York, NY. 2. Basic and Applied Social Psychology (BASP) PhD Program, Graduate Center of the City University of New York, New York, NY. 3. Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR), New York, NY. 4. New York City Department of Health and Mental Hygiene, Bureau of Public Health Clinics, New York, NY. 5. New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV and STI, New York, NY. 6. Howard Brown Health, Chicago, IL; and. 7. Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, NY.
Abstract
BACKGROUND: Pre-exposure prophylaxis (PrEP) for HIV prevention requires engagement throughout the PrEP care continuum. Using data from a PrEP navigation program, we examine reasons for PrEP discontinuation. SETTING: Participants were recruited from New York City Health Department Sexual Health Clinics with PrEP navigation programs. METHODS: Participants completed a survey and up to 3 interviews about PrEP navigation and use. This analysis includes 94 PrEP initiators that were PrEP-naive before their clinic visit, started PrEP during the study, and completed at least 2 interviews. Interview transcripts were reviewed to assess reasons for PrEP discontinuation. RESULTS: Approximately half of PrEP initiators discontinued PrEP during the study period (n = 44; 47%). Most participants (71%) noted systemic issues (insurance or financial problems, clinic or pharmacy logistics, and scheduling barriers) as reasons for discontinuation. One-third cited medication concerns (side effects, potential long-term side effects, and medication beliefs; 32%) and behavioral factors (low relevance of PrEP because of sexual behavior change; 34%) as contributing reasons. Over half (53.5%) highlighted systemic issues alone, while an additional 19% attributed discontinuation to systemic issues in combination with other factors. Of those who discontinued, approximately one-third (30%) restarted PrEP during the follow-up period, citing resolution of systemic issues or behavior change that increased PrEP relevance. CONCLUSIONS: PrEP continuation is dependent on interacting factors and often presents complex hurdles for patients to navigate. To promote sustained engagement in PrEP care, financial, clinic, and pharmacy barriers must be addressed and counseling and navigation should acknowledge factors beyond sexual risk that influence PrEP use.
BACKGROUND: Pre-exposure prophylaxis (PrEP) for HIV prevention requires engagement throughout the PrEP care continuum. Using data from a PrEP navigation program, we examine reasons for PrEP discontinuation. SETTING: Participants were recruited from New York City Health Department Sexual Health Clinics with PrEP navigation programs. METHODS: Participants completed a survey and up to 3 interviews about PrEP navigation and use. This analysis includes 94 PrEP initiators that were PrEP-naive before their clinic visit, started PrEP during the study, and completed at least 2 interviews. Interview transcripts were reviewed to assess reasons for PrEP discontinuation. RESULTS: Approximately half of PrEP initiators discontinued PrEP during the study period (n = 44; 47%). Most participants (71%) noted systemic issues (insurance or financial problems, clinic or pharmacy logistics, and scheduling barriers) as reasons for discontinuation. One-third cited medication concerns (side effects, potential long-term side effects, and medication beliefs; 32%) and behavioral factors (low relevance of PrEP because of sexual behavior change; 34%) as contributing reasons. Over half (53.5%) highlighted systemic issues alone, while an additional 19% attributed discontinuation to systemic issues in combination with other factors. Of those who discontinued, approximately one-third (30%) restarted PrEP during the follow-up period, citing resolution of systemic issues or behavior change that increased PrEP relevance. CONCLUSIONS: PrEP continuation is dependent on interacting factors and often presents complex hurdles for patients to navigate. To promote sustained engagement in PrEP care, financial, clinic, and pharmacy barriers must be addressed and counseling and navigation should acknowledge factors beyond sexual risk that influence PrEP use.
Authors: Julia L Marcus; Leo B Hurley; Charles Bradley Hare; Dong Phuong Nguyen; Tony Phengrasamy; Michael J Silverberg; Juliet E Stoltey; Jonathan E Volk Journal: J Acquir Immune Defic Syndr Date: 2016-12-15 Impact factor: 3.731
Authors: Aaron J Siegler; Farah Mouhanna; Robertino Mera Giler; Kevin Weiss; Elizabeth Pembleton; Jodie Guest; Jeb Jones; Amanda Castel; Howa Yeung; Michael Kramer; Scott McCallister; Patrick S Sullivan Journal: Ann Epidemiol Date: 2018-06-15 Impact factor: 3.797
Authors: Alexa B D'Angelo; Javier Lopez-Rios; Anthony W P Flynn; Ian W Holloway; David W Pantalone; Christian Grov Journal: Transl Behav Med Date: 2021-03-16 Impact factor: 3.046
Authors: David P Serota; Eli S Rosenberg; Patrick S Sullivan; Annie L Thorne; Charlotte-Paige M Rolle; Carlos Del Rio; Scott Cutro; Nicole Luisi; Aaron J Siegler; Travis H Sanchez; Colleen F Kelley Journal: Clin Infect Dis Date: 2020-07-27 Impact factor: 9.079
Authors: Ian W Holloway; Ryan Dougherty; Jennifer Gildner; Sean C Beougher; Craig Pulsipher; Jorge A Montoya; Aaron Plant; Arleen Leibowitz Journal: J Acquir Immune Defic Syndr Date: 2017-01-01 Impact factor: 3.771
Authors: Matthew A Spinelli; Hyman M Scott; Eric Vittinghoff; Albert Y Liu; Rafael Gonzalez; Alicia Morehead-Gee; Monica Gandhi; Susan P Buchbinder Journal: Open Forum Infect Dis Date: 2019-02-26 Impact factor: 3.835
Authors: David P Serota; Eli S Rosenberg; Annie L Thorne; Patrick S Sullivan; Colleen F Kelley Journal: J Int AIDS Soc Date: 2019-10 Impact factor: 5.396