High priority groups are more likely to stop taking HIV prevention treatment, study finds

A broad and detailed review of patients taking HIV prevention drug therapy reveals high adherence soon after patients receive the prescription, but less consistent use thereafter, especially among groups considered high priority for receive the drug.

The study, published on August 26 in JAMA network open, examined data from 13,906 Kaiser Permanente members in Northern California referred for pre-exposure prophylaxis, or PrEP, therapy between 2012 and 2019. The study found that some groups were more likely to stop taking the drug. PrEP: young people, blacks and Latinos, women, and people with substance use disorders.

The results suggest that targeted strategies are needed to support the use of this highly effective protective drug in groups at increased risk of contracting HIV, said lead author Carlo Hojilla, RN, PhD, researcher at Kaiser Permanente Northern California Division of Research.

The findings have important implications which suggest that access to health care is a great way to get people out the door, but we need more effective strategies to ensure that people who have a continued need for PrEP. remain on the drug. These are groups we want to reach, and we need innovative approaches to keep them engaged in PrEP care. “

Carlo Hojilla, inf. aut., PhD, researcher, Kaiser Permanente

The study found that a high rate of patients referred for HIV prevention care were prescribed PrEP (88%) and most of them filled their original prescriptions (98%). There are 2 main brands of PrEP therapy (Truvada and Descovy), which are usually taken daily to prevent getting HIV. “These results were encouraging,” Hojilla said. “Kaiser Permanente has been very successful in increasing uptake of PrEP therapy. “

However, there was a significant inconsistency in use over the study period, with about half of the users stopping the PrEP drug at least once; 60% of those who quit later refilled a prescription. This analysis did not examine why users stopped or restarted drugs, the authors said, and some users may have stopped PrEP because of a decreased risk of contracting HIV. Previous studies have also documented medical mistrust, stigma, homophobia, and transphobia as barriers to the uptake and persistence of PrEP in some communities.

“We know that cost can be a big concern for some people, and this study included a period before PrEP-related services were provided free of charge due to changes to the recommendations of the US Task Force on Preventive Services.” , Hojilla said.

The study was also carried out before the introduction of a new dosage option known as 2-1-1, or on demand, which allows the user to take PrEP only at the time of one. potential exposure to HIV, with a similar level of efficacy in daily dosing. It is possible that part of the discontinuation reflected in the study was due to patients who chose not to take the drug daily because they had only occasional exposure to the risk, even before the Dosage 2-1-1 is not formally recommended, said lead author Jonathan Volk, MD, infectious disease specialist with the Permanent Medical Group.

Among those who remained on PrEP treatment, there were no new HIV infections, according to the study. “It shows how amazingly well PrEP works when taken,” said Dr Volk. “But there are significant opportunities for us to maximize the impact of this life-saving therapy at the population level. To do this, we need to avoid attrition along the continuum of care, especially in helping patients stay on PrEP during times of risk for HIV acquisition. “

The same Kaiser Permanente research group reported in 2015 that PrEP effectively stops HIV infections in early adopters. They also reported in 2020 that on-demand dosing was effective in preventing HIV in 279 male patients.