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. 2024 Jul;53(7):2445-2452.
doi: 10.1007/s10508-024-02862-0. Epub 2024 May 22.

Factors Associated with PrEP Persistence and Loss of Follow-Up: A 5-Year Historic Cohort

Clément Le Roux  1   2   3 , Marc-Florent Tassi  4   5   6 , Cathie Faussat  7   8   6 , Catherine Aumond  9   10 , Guillaume Gras  8   11   10 , Karl Stefic  6   12 , Leslie Grammatico-Guillon  4   7   6
Affiliations

Factors Associated with PrEP Persistence and Loss of Follow-Up: A 5-Year Historic Cohort

Clément Le Roux et al. Arch Sex Behav. 2024 Jul.

Abstract

Objective: HIV Pre-Exposure Prophylaxis (PrEP) has been used in France since 2016. Its effectiveness is no longer to be demonstrated. However, follow-up and adherence remain the main pitfalls. The main objective of this study was to identify factors associated with persistence or loss of PrEP follow-up.

Design: An historic cohort of PrEP users was compiled from the database of consultations in the Indre-et-Loire dedicated sexual health centers (CeGIDD) from June 2016 to June 2021.

Methods: Kaplan-Meier curves were performed to compare the group of persistent PrEP users to the discontinuation group. Factors associated with PrEP discontinuation were identified using Cox modelling, considering time-dependent variables. Final variables included in the model were selected based on the Akaike Information Criterion (AIC) and clinical relevance.

Results: Over the period, 568 PrEP users were included in the cohort. Median follow-up was 2.3 years. A quarter of users were lost to follow-up within 3 months after PrEP initiation. Sexual risk reduction AIDS community-based support (HR = 0.65[0.42;0.99]), being in a couple (HR = 0.51[0.38;0.68]), and history of syphilis (HR = 0.57[0.40;0.81]) were significantly associated with persistence of follow-up. Remote consultations (HR = 2.74[1.63;4.61]), chemsex practices (HR = 2.01[1.29;3.14]), and side effects (HR=1.72[1.03;2.88]) were significantly associated with a loss of follow-up.

Conclusion: These results suggest that more sexual risk reduction AIDS community-based counseling could be a key, necessary for supporting PrEP users in their follow-up pathway. Indeed, AIDS community-based support could be used to build a basis for developing safe pathways. Remote consultations could represent a response to the issue of access to PrEP. To create a significant impact on global HIV incidence, the PrEP offer must be extended, and at-risk PrEP users supported to maintain PrEP use.

Keywords: HIV pre-exposure prophylaxis; HIV prevention; PrEP adherence; Sexually transmitted infections; community based-support.

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