Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 1;34(13):1951-1957.
doi: 10.1097/QAD.0000000000002618.

A taxonomy of pragmatic measures of HIV preexposure prophylaxis use

Maria Pyra  1   2 , Laura Rusie  1 , Michael Castro  1 , Kristin Keglovitz Baker  1 , Moira McNulty  2 , Nick Bohm  1 , Andrei Prokurat  1 , John Schneider  1   2
Affiliations

A taxonomy of pragmatic measures of HIV preexposure prophylaxis use

Maria Pyra et al. AIDS. .

Abstract

Objectives: As delivery of preexposure prophylaxis (PrEP) becomes an HIV prevention priority in the United States, standard, pragmatic measures of PrEP use are needed to compare and evaluate prevention implementation programs. By using readily available electronic health record data, we describe and compare measures of persistence and retention.

Design: Retrospective cohort.

Methods: Using electronic health record prescription data for patients at a large urban Federally Qualified Health Center from 2015 to 2019, we calculated measures of persistence and retention and compared them to pharmacy claims data, PrEP biomarkers, and HIV outcomes.

Results: Total PrEP time was 19.8 months on average. During this period, average adherence by medication prescription ratio (MRxR) was 89%; 77% of patients had an MRxR at least 85% and 90% have an MRxR at least 57%. Over the first 6 months, average proportion of days covered (PDC) at least 85% was 53% and PDC at least 57% was 57%. Prescription fill rates, based on claims data from a pharmacy partner, ranged from 45 to 60%. Using tenofovir-diphosphate as the gold standard, PDC had high sensitivity (97%) but low specificity (≤13%). As a measure of retention, over the first 6 months, 59% of patients had quarterly HIV tests.

Conclusion: Total PrEP time is useful measure of overall persistence, while PDC can assess persistence and adherence at a specific time point. Adherence by PDC is more conservative compared with MRxR; both will overestimate true adherence. Retention in care can be measured by quarterly HIV tests. Using consistent terminology and reporting timepoints and adherence thresholds will help reporting and comparing PrEP delivery programs.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest:

We declare no other conflicts of interest.

References

    1. Marcus JL, Hurley LB, Hare CB, Nguyen DP, Phengrasamy T, Silverberg MJ, et al. Preexposure Prophylaxis for HIV Prevention in a Large Integrated Health Care System: Adherence, Renal Safety, and Discontinuation. J Acquir Immune Defic Syndr 2016; 73:540–546. - PMC - PubMed
    1. van Epps P, Maier M, Lund B, Howren MB, Beck B, Beste L, et al. Medication Adherence in a Nationwide Cohort of Veterans Initiating Pre-exposure Prophylaxis (PrEP) to Prevent HIV Infection. J Acquir Immune Defic Syndr 2018; 77:272–278. - PubMed
    1. Krakower D, Maloney KM, Powell VE, Levine K, Grasso C, Melbourne K, et al. Patterns and clinical consequences of discontinuing HIV preexposure prophylaxis during primary care. J Int AIDS Soc 2019; 22. doi: 10.1002/jia2.25250 - DOI - PMC - PubMed
    1. Dombrowski JC, Golden MR, Barbee LA, Khosropour CM. Patient Disengagement from an HIV Pre-Exposure Prophylaxis Program in a Sexually Transmitted Disease Clinic. Sex Transm Dis 2018; 45:e62–e64. - PMC - PubMed
    1. Spinelli MA, Scott HM, Vittinghoff E, Liu AY, Morehead-Gee A, Gonzalez R, et al. Provider Adherence to Pre-exposure Prophylaxis Monitoring Guidelines in a Large Primary Care Network. Open Forum Infect Dis 2018; 5. doi: 10.1093/ofid/ofy099 - DOI - PMC - PubMed

Publication types

Substances