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Mind the gaps: prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California

Mind the Gaps: Cobertura de recetas e incidencia de VIH entre pacientes recibiendo profilaxis pre-exposición de un centro de salud grande y federalmente calificado en Los Ángeles, CA

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Abstract

We conducted a records-based cohort study of patients who initiated pre-exposure prophylaxis (PrEP) at a large federally qualified health center in Los Angeles, CA to characterize patterns of PrEP use, identify correlates of PrEP discontinuation, and calculate HIV incidence. Of 3121 individuals initiating PrEP between 2014 and 2017, 42% (n = 1314) were active (i.e., had a current PrEP prescription) in April 2018. HIV incidence was 0.1/100 person-years among active PrEP patients, compared to 2.1/100 person-years among patients who discontinued. Compared to patients accessing PrEP through government programs with no prescription copay, risk of discontinuation was higher among those with private insurance (ARR = 1.4, 95% CI 1.2, 1.7), or no insurance (ARR = 4.5, 95% CI 3.2, 6.4). Sixty-three percent of active PrEP patients had gaps between PrEP prescriptions, averaging one gap per year (median length = 65 days). Increasing access to free or low-cost PrEP can improve PrEP continuity.

Resumen

Llevamos a cabo un estudio de cohorte basada en registros de pacientes quienes iniciaron profilaxis pre-exposición (PrEP) en un centro de salud grande y federalmente calificado en Los Ángeles, CA para caracterizar patrones del uso de PrEP, identificar correlaciones de la discontinuación de PrEP y calcular la incidencia de VIH. De los 3121 individuos quienes iniciaron PrEP entre los años 2014–2017, 42% (n = 1314) fueron activos (i.e. actualmente tenían una receta para PrEP) en abril 2018. La incidencia de VIH fue 0.1/100 persona-años entre los pacientes activos con PrEP, comparada a 2.1/100 personas-años entre los pacientes quienes lo dejaron de usar. Comparado a los pacientes accediendo a PrEP a través de programas gubernamentales sin copago para las recetas, el riesgo de discontinuación de PrEP fue más alto entre los con seguro de salud privado (RRA = 1.4, 95% CI 1.2, 1.7) o los que no tienen seguro de salud (RRA = 4.5, 95% CI 3.2, 6.4). Sesenta y tres por ciento de los pacientes activos de PrEP tenían lapsos sin recetas de PrEP, con un promedio de uno lapso por año (duración del lapso mediano = 65 días). Ampliando el acceso a PrEP gratis o con bajo costo puede mejorar la continuidad de tomar PrEP.

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Acknowledgments

The authors wish to thank the PrEP navigation team, counselors, and clinicians at the Los Angeles LGBT Center. CLS was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number T32DA035165. SS was supported by the National Institute of Mental Health under award number P30 MH058107. MJ was supported by the National Institutes of Health and National Institute of Allergy and Infectious Disease, grant number K01AI091861. MRB was supported by the UCLA Postdoctoral Fellowship Training Program in Global HIV Prevention Research (Currier and Gorbach, PIs); T32MH080634. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. There are no conflicts of interest to report.

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Authors and Affiliations

  1. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA

    Chelsea L. Shover, Marjan Javanbakht, Sung-Jae Lee & Pamina M. Gorbach

  2. Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA

    Chelsea L. Shover, Robert K. Bolan, Nicole J. Cunningham, Matthew R. Beymer & Michelle A. DeVost

  3. Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA

    Chelsea L. Shover

  4. Departments of Family Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Steven Shoptaw

  5. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Sung-Jae Lee

  6. Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Matthew R. Beymer & Pamina M. Gorbach

  7. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Michelle A. DeVost

Authors
  1. Chelsea L. Shover
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  2. Steven Shoptaw
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  3. Marjan Javanbakht
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  9. Pamina M. Gorbach
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Corresponding author

Correspondence to Chelsea L. Shover.

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The study was approved by the Institutional Review Board at the University of California, Los Angeles (IRB#17-000717).

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Shover, C.L., Shoptaw, S., Javanbakht, M. et al. Mind the gaps: prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California. AIDS Behav 23, 2730–2740 (2019). https://doi.org/10.1007/s10461-019-02493-w

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