Presented at HIVR4P 2018 – (P14.01) Online Survey about Reasons for Stopping PrEP is an Opportunity to Re-engage Inactive PrEP Clients
Chelsea Shover, David Flores, Matthew Beymer, Michelle DeVost, Pamina Gorbach, Risa Flynn, K. Rivet Amico, Paul Chavez, Phoebe Lyman, Brian Toynes, Robert Bolan
Background: Studies of HIV pre-exposure prophylaxis (PrEP) in community settings reveal continuation challenges. We examined the contribution of health services barriers, medication factors, transitions between healthcare providers, and changes in sexual risk to PrEP discontinuation among patients who initiated PrEP at a large community clinic in Los Angeles, CA.
Methods: From Feb 2018 – Apr 2018, 810 patients who initiated PrEP at the Los Angeles LGBT Center between Jan 2016 and Sept 2017 with current gaps in PrEP care (>120 days from last PrEP visit) were invited to ake an online survey which assessed current PrEP use and reasons for stopping PrEP or missing doses. During that period, 2,418 patients had been prescribed PrEP.
Results: Of 168 patients who took the survey, 49% (n=83) had stopped taking PrEP, 43% (n=72) had taken PrEP within the past seven days (31 had transitioned to a different provider), 6% (n=10) reported they had never taken PrEP, and 3 did not report when they last took PrEP. Of those not currently taking PrEP (n=93), 74% (n=69) provided reasons for stopping PrEP or missing doses. Most common reasons were entering a monogamous relationship (43%), cost (38%), side effects (38%), insurance problem (36%), “I did not think I needed to take PrEP” (33%), forgetting (29%), problem filling prescription (28%), not having anal sex (28%). At the end of the survey, 23 (25%) of those who discontinued asked to be called to schedule another PrEP appointment. By mid-April, 5 (22%) had attended appointments and been prescribed PrEP again. One patient who became HIV positive after discontinuing PrEP was linked to HIV care.
Conclusions: The survey enabled us to re-engage patients who still wanted PrEP. Lowering health services barriers and providing ongoing PrEP education may improve continuation. By developing personal PrEP action plans, providers can support patients in managing their engagement in PrEP through seasons of risk if they do not intend to be on PrEP long-term or indefinitely.