Young people taking PrEP pills | Image source: nito – stock.adobe.com
Results of a new analysis of pre-exposure prophylaxis (PrEP) adoption and retention rates among Latino men who have sex with men (MSM) receiving care at a federally qualified health center (FQHC) in El Paso, Texas , high rates of pre-exposure prophylaxis (PrEP) use were reported, primarily with discontinuation of PrEP after the first follow-up visit Journal of Racial and Ethnic Health Disparities.1
These findings indicate two main areas of focus: enhancing long-term PrEP persistence and improving support for restarting PrEP.
Despite extremely high HIV prevalence among Latino MSM, access to and use of PrEP remains suboptimal among Latino MSM, and El Paso has the third highest HIV prevalence among MSM, per There were 28.5 cases of infection among 100 MSM. The researchers emphasize that this study is one of the few to quantify persistence on the PrEP continuum among a predominantly Latino MSM population.
292 patients included in this retrospective cohort analysis were eligible to receive PrEP at FQHC (San Vicente Center) between January 30, 2019, and August 15, 2021; 91% (n = 235) were Latina Origin. PrEP discontinuation was defined as an interval between PrEP visits of more than 120 days, and the outcomes of interest were the median time to first PrEP discontinuation and duration of PrEP adherence at 3 months.
Among patients prescribed nucleoside/nucleotide reverse transcriptase inhibitor antiviral drugs, 70% experienced PrEP discontinuation,2 Among them, researchers found 3 main categories of PrEP termination
- Discontinued early and never restarted: Clients who did not return to the clinic after their first PrEP visit (27% of clients who discontinued medication, 19% of the entire study population)
- Stopping early and restarting later: Customers who stopped after an initial visit but eventually returned (21% vs. 14% respectively)
- Later discontinued: Clients who returned after the initial visit but subsequently discontinued PrEP (52% vs. 37%); this group was further divided into “later discontinued, never restarted” and “later discontinued, later restarted”
Additionally, an analysis of patients who later discontinued PrEP showed that 56% subsequently restarted PrEP, with the authors noting, “We calculated these categories among the majority subset of Latino MSM and found that they were nearly identical to the overall patient population. .”
For the other two categories of patients who discontinued, those classified as “early discontinued and never restarted,” those classified as “late discontinued” ultimately returned to PrEP care after a median of 199 days. , and later restarted” was 169 days.
The median time to first discontinuation was 202 days (95% CI, 179-266) days. Among Latino MSM, this time was slightly longer, 250 days (95% CI, 179-267) days.
The majority of people in this analysis are 25 to 29 years old (28%) or 35 and older (29%), cisgender men (90%), Latino (91%) or non-Latino white (6% ). 1% each identify as black non-Latino, others identify as non-Latino, 95% live in El Paso, and 57% are uninsured. The top 3 indications for PrEP were MSM (89%), multiple sexual partners in the past 3 months (53%), and history of sexually transmitted infections (40%). Fourteen percent tested positive for syphilis at the first study visit.
Overall, 82% (95% CI, 76%-87%) of the study population were still taking PrEP at 3 months after treatment initiation, but this dropped to 55% (95% CI, 46%-62 %) within 6 months after commencement.
“In this study of PrEP programs within FQHCs along the U.S.-Mexico border, we found that 3-month PrEP retention rates were high among a primarily Latino MSM patient population, but most patients discontinued at least 11 months of PrEP,” the study authors emphasized. “Most studies of predominantly Latino MSM report disproportionately low cross-sectional measures of PrEP uptake and coverage, but this study is one of the few to examine the PrEP continuum in a predominantly Latino MSM population. One of the studies to quantify the sustainability of
They added that their findings showed higher retention rates at 3 and 6 months compared with previous studies, which reported 3-month retention rates ranging from 37% to 50%.3-5
The Centro San Vicente clinic is considered a safe space for the LGBTQ+ community, and the authors believe the higher PrEP retention rates they saw may be due to the trust and confidentiality the clinic has established with patients, as well as the fact that services are provided in Spanish. This is especially important given that barriers such as government distrust, PrEP-related stigma, economic inequality, and heterosexism may prevent Latino MSM from retaining PrEP.
“Our findings suggest the need for culturally tailored interventions to improve long-term PrEP retention and support Latino MSM to re-initiate PrEP,” the authors concluded. “More research is needed to understand the nuances of PrEP discontinuation, to develop plans to support patients in continuing and reinitiating PrEP.”
refer to
1. Tiley T, Anaya G, Gallegos PA, Castaneda R, Khosropour CM. Preexposure prophylaxis use and discontinuation at a federally qualified health center in a Mexico-U.S. border city. J Racial and ethnic health disparities. Published online on October 3, 2023. doi:10.1007/s40615-023-01807-y
2. Ghoshal M. What is HIV PrEP? How does it work? Healthline. February 28, 2023. Accessed 3 October 2023. https://www.healthline.com/health/hiv-aids/hiv-prevention/hiv-prep#bottom-line
3. Goodman A, Patten L, Castillo-Mancilla J, Zimmer S, Madinger N, Frasca K. Factors associated with retention and adherence to comprehensive, diverse HIV pre-exposure prophylaxis clinics. HIV retrovirus. 2022;38(4):327-335. doi:10.1089/AID.2021.0130
4. Zucker J, Carnevale C, Richards P, et al. Predictors of disengagement from care among individuals receiving pre-exposure prophylaxis (PrEP). Journal of Acquired Immunodeficiency Syndrome. 2019;81(4):e104-e108. doi:10.1097/QAI.0000000000002054
5. Zhang Jie, Li Chao, Xu Jie, et al. Discontinuation, nonadherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis. The Lancet HIV. 2022;9(4):e254-e268.