Journal article
Medication Adherence in a Nationwide Cohort of Veterans Initiating Pre-exposure Prophylaxis (PrEP) to Prevent HIV Infection
Journal of acquired immune deficiency syndromes (1999), Vol.77(3), pp.272-278
03/01/2018
DOI: 10.1097/QAI.0000000000001598
PMID: 29210835
Abstract
Current guidelines for pre-exposure prophylaxis (PrEP) to prevent HIV infection call for long-term, daily use of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). Little is known about long-term adherence with TDF/FTC prescribed for PrEP in routine clinical practice.
Veterans Health Administration (VHA) clinics.
We used VHA data to create a nationwide cohort of Veterans initiating PrEP between July 1, 2012, and June 30, 2016. We examined pharmacy refill data to estimate adherence based on the proportion of days covered (PDC) by TDF/FTC in the first year and used logistic regression to identify patient characteristics associated with high adherence (ie, PDC >0.8). We also quantified how often Veterans discontinued PrEP in the first year, based on a gap of 120 days or more in medication possession.
Among 1086 individuals initiating PrEP, the median PDC for TDF/FTC in the first year was 0.74 (interquartile range 0.40-0.92). In multivariable analysis, high adherence was associated with older age (odds ratio 1.97; 1.41-2.74 for age 50-64 compared with <35), white compared with black race (odds ratio 2.12; 1.53-2.93), and male sex (odds ratio 3.39; 1.37-8.42). Forty-four percent discontinued PrEP in the first year.
First-year adherence with TDF/FTC was overall high in a nationwide cohort of PrEP users. Differences in adherence by age, race, and sex suggest potential for disparities in PrEP effectiveness in routine clinical practice.
Details
- Title: Subtitle
- Medication Adherence in a Nationwide Cohort of Veterans Initiating Pre-exposure Prophylaxis (PrEP) to Prevent HIV Infection
- Creators
- Puja van Epps - Department of Internal Medicine, Case Western School of Medicine, Cleveland, OHMarissa Maier - Department of Internal Medicine, Oregon Health and Sciences University, Portland, ORBrian Lund - VHA Office of Rural Health Resource Center, Iowa City, IAMatthew Bryant Howren - VHA Office of Rural Health Resource Center, Iowa City, IABrice Beck - VHA Office of Rural Health Resource Center, Iowa City, IALauren Beste - Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WAAvy Skolnik - Center for Healthcare Organization and Implementation Research (CHOIR) at the Bedford VA Medical Center, Bedford, MAMary Vaughan-Sarrazin - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IAMichael E Ohl - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Journal of acquired immune deficiency syndromes (1999), Vol.77(3), pp.272-278
- Publisher
- United States
- DOI
- 10.1097/QAI.0000000000001598
- PMID
- 29210835
- ISSN
- 1525-4135
- eISSN
- 1944-7884
- Language
- English
- Date published
- 03/01/2018
- Academic Unit
- Psychiatry; Health Management and Policy; Epidemiology; Psychological and Brain Sciences; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063143502771
Metrics
12 Record Views