In the U.S., sexual and gender minority populations are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a key prevention method, but its effectiveness relies on consistent usage. While a significant body of research has addressed PreP initiation and adherence, far less attention has been paid to the reasons for and consequences of PrEP discontinuation.
A team of investigators conducted a four-year U.S. national cohort study exploring PrEP discontinuation among sexual and gender minority people who initiated PrEP. "Our cohort was entirely comprised of individuals who met clinical indication for PrEP care but were not on PrEP at the time of enrollment. We provided information about PrEP as well as resources to help participants engage in care and then prospectively followed them for four years, says Christian Grov, Professor at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) and the study's principal investigator. "Unfortunately, we observed that need for PrEP remained high, and more alarming, high rates of discontinuation among those who started."
Overall, they found a high annual rate of discontinuation (35–40 percent) after PrEP initiation. Unsurprisingly, HIV incidence among those who discontinued PrEP was markedly higher than among those who continued its use.
Multivariable analysis with 6,410 person-years identified housing instability and prior history of PrEP discontinuation as predictors of discontinuation. Conversely, older age, clinical indication for PrEP, and having health insurance were associated with ongoing PrEP use. To promote sustained PrEP use, strategies should focus on supporting those at high risk for discontinuation, such as younger people, those without stable housing or health insurance, and prior PrEP discontinuers.
"Our findings highlight the urgent need for targeted support to ensure sustained PrEP use, especially social determinants of health such as housing instability and health insurance," says first author Yan Guo, research scientist at CUNY SPH. "Let's focus on bridging these gaps for better HIV prevention."
