Spatio-temporal Trends of PrEP Use and Persistent Users’ Individual and Place-based Characteristics in the U.S. Population and among men who have sex with men (MSM)
Open AccessBackground: Daily oral PrEP substantially reduces the risk of HIV acquisition when PrEP coverage and adherence are high among populations at-risk. Purpose: We explored, for the first time, spatio-temporal trends of PrEP use and identified individual and place-based characteristics associated with persistence on PrEP in the general population and among men who have sex with men (MSM) in the U.S. Methods: We used national county-level pharmacy records-based data from Symphony Health (SH) and small-area spatio-temporal modelling to describe the pace of progress in PrEP use relative to the general and to MSM populations (2012-2018). SH data from 232,196 PrEP users were also used to compare the odds of PrEP re-initiation and persistence on PrEP by demographic characteristics. Latent longitudinal patterns of PrEP use among all users in the US were identified using repeated-measures latent class analysis. We also examined the association between individual and place-based covariates and persistence on PrEP in the general population and among MSM using multilevel models. Results: Counties of the Midwest, the upper South and upper West had the slowest increase in PrEP use relative to the general and to MSM populations. Persistence on PrEP increased by age. Females and people on Medicaid/Medicare had a shorter persistence on PrEP and lower odds of re-initiating PrEP after first discontinuation. Among current MSM PrEP users, controlling for individual and place-based characteristics, persistence on PrEP was significantly associated with younger age, lower number of anal sex partners in the last 12 months, better adherence on medication in the last month, and ever injecting drugs. Conclusion: Our study filled major gaps in our understanding of PrEP use patterns in the US. Identifying areas with fast improvement in PrEP use can inform PrEP scale-up programs. This dissertation can also inform retention in care efforts to identify users who are likely to discontinue medication use despite continued risk of infection.
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Mouhanna_gwu_0075A_15227.pdf | 2022-03-06 | Open Access |
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