Pre-exposure prophylaxis prescribing and retention in care among heterosexual women at a community-based comprehensive sexual health clinic.
In the United States, heterosexual women account for 20% of new HIV infections. As a user-controlled HIV prevention method, pre-exposure prophylaxis (PrEP) has substantial potential to reduce new infections among women. However, among women, PrEP is vastly underutilized. To guide efforts to increase women-at-risk's PrEP use, we sought to describe the characteristics of women prescribed PrEP as well as their retention in PrEP care. We conducted a chart review of women who received care at a comprehensive sexual health clinic within a large urban health care system. Referral sources included the health care system's clinics and HIV testing program, as well as local community-based organizations. From 1 December 2014 to 5 August 2016, 554 women received care at the clinic. During this period, 21 heterosexual women (3.8%) received at least one prescription for daily oral PrEP. For women prescribed PrEP, median age was 35 years old (range: 20-52). The majority (66.7%) were either Latina or non-Latina Black and most (81.2%) had public health insurance. The most common PrEP indication was being in a known sero-discordant partnership (85.7%). Of women in such partnerships, 83.3% reported their male partner was currently taking antiretroviral medications (ARVs) and 16.7% reported trying to conceive with their partner (not mutually exclusive). Of women with ARV-using partners, 66.7% reported that their partners were virally suppressed. Retention in PrEP care at three months was 61.1% and, at six months, 37.5%. Further study is necessary to expand PrEP to women whose risk factors extend beyond being in a known sero-discordant partnership, and to understand the reasons for the observed drop-off in PrEP care visits in real-world settings.
a Division of General Internal Medicine , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , USA.
Oni J
OJ
Blackstock
a Division of General Internal Medicine , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , USA.
Viraj V
VV
Patel
b Division of Infectious Diseases , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , USA.
Uriel
U
Felsen
b Division of Infectious Diseases , Montefiore Medical Center, Albert Einstein College of Medicine , Bronx , USA.
Connie
C
Park
c Department of Medicine , Albert Einstein College of Medicine , Bronx , USA.
Sachin
S
Jain
D000328:Adult; D001741:Black or African American; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D044383:Black People; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D020010:Heterosexuality; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D065129:Pre-Exposure Prophylaxis; D021841:Safe Sex; D012747:Sexual Partners; D055815:Young Adult
D019380:Anti-HIV Agents
HIV; PrEP; antiretroviral agents; primary prevention; women