Retention in care outcomes for HIV pre-exposure prophylaxis implementation programmes among men who have sex with men in three US cities.
Despite the efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV transmission, few studies have evaluated PrEP use and retention in care outcomes in real-world settings outside of clinical trials.



Data were collected from PrEP clinical care programmes in three mid-size US cities: Providence, Rhode Island (RI); Jackson, Mississippi (MS); and St. Louis, Missouri (MO). We assessed the demographic and social characteristics of patients prescribed PrEP and documented their insurance and copayment experiences. We assessed retention in PrEP care at three and six months. Multivariate analyses were used to predict retention in care among men who have sex with men (MSM). HIV acquisition among the cohort was also assessed.



A total of 267 (RI: 117; MS: 88; MO: 62) patients were prescribed PrEP; 81% filled prescriptions (RI: 73%; MS: 82%; MO: 94%; p<0.001). Patients in MS and MO were more commonly African American than in RI (72% and 26% vs. 7%, respectively), but less frequently Latino (2% and 3% vs. 24%, respectively). More patients reported living below the federal poverty line in MS (52%) compared to MO (23%) and RI (26%). Most patients were MSM (RI: 92%; MS: 88%; MO: 84%). The majority of MSM reported recent condomless anal sex (RI: 70%; MS: 65%; MO: 75%). Among 171 patients prescribed PrEP at least six months beforehand, 72% were retained in care at three months (RI: 68%; MS: 70%; MO: 87%; p=0.12) and 57% were retained in PrEP care at six months (RI: 53%: MS: 61%; MO: 63%; p=0.51). Insurance status and medication costs were not found to be significant barriers for obtaining PrEP. Three patients became infected with HIV during the six-month period after being prescribed PrEP (1.1%; 3/267), including one in RI (suspected acute HIV infection), one in MO (confirmed poor adherence) and one in MS (seroconverted just prior to initiation).



PrEP initiation and retention in care differed across these distinct settings. In contrast, retention in PrEP care was consistently suboptimal across sites. Further research is needed to identify the individual, social and structural factors that may impede or enhance retention in PrEP care.
Division of Infectious Diseases, The Miriam Hospital, Brown University, Providence, RI, USA; pchan@lifespan.org.
Philip A
PA
Chan
Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA.
Leandro
L
Mena
Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA.
Rupa
R
Patel
Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
Catherine E
CE
Oldenburg
Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA.
Laura
L
Beauchamps
Department of Sociomedical Sciences, Columbia University, New York, NY, USA.
Amaya G
AG
Perez-Brumer
Department of Social Work, North Carolina Agricultural and Technical State University, Greensboro, NC, USA.
Sharon
S
Parker
The Fenway Institute, Fenway Health, Boston, MA, USA.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
Kenneth H
KH
Mayer
The Fenway Institute, Fenway Health, Boston, MA, USA.|Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.|Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Matthew J
MJ
Mimiaga
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Amy
A
Nunn
D000328:Adult; D002947:Cities; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis; D014481:United States
HIV; implementation; men who have sex with men; pre-exposure prophylaxis