PrEP Continuation, HIV and STI Testing Rates, and Delivery of Preventive Care in a Clinic-Based Cohort

Abstract

HIV pre-exposure prophylaxis (PrEP) has been demonstrated to be a safe and effective method of reducing HIV incidence. Questions remain regarding PrEP's efficacy and outcomes in real-world clinical settings. We conducted a retrospective review to assess PrEP outcomes in an academic clinic setting and focused on retention in care, reasons for discontinuation, and receipt of appropriate preventive care (immunizations, HIV testing, and STI testing). One hundred thirty-four patients were seen between 2010 and 2016 over 309 visits. One hundred sixteen patients (87%) started daily PrEP and of those, 88 (76%) attended at least one 6-month follow-up visit. Over 60% of PrEP patients completed all recommended STI screening after starting PrEP. Only 40% of patients had all appropriate immunizations at baseline; 78% had all appropriate immunizations at study completion. This study demonstrated high rates of both retention and of attaining recommended preventive care in a clinical setting outside of the rigors of clinical trials.

Keywords: HIV; pre-exposure prophylaxis; prevention; preventive care; real-world clinic setting.

Figure 1. PrEP Cascade (n=139)

Demonstrates the PrEP cascade of care beginning when patients made initial contact by scheduling appointments followed by incidence of patients attending their first appointment, patients prescribed PrEP, and patients that retained in care at 3, 6, and 12 months. Dotted sections denotes patients that received PrEP prescriptions at previous follow-up but were not yet due for 3, 6, or 12 month follow-up, respectively. Crossed lines denotes patients that moved away from study city but planned to remain on PrEP (not included in analysis). Percentages are derived from total number of patients that initially made appointments.