Study: Black, Latinos More Likely to Stop HIV-Prevention Therapy

Investigators find there is strong adherence soon after patients fill prescriptions but less consistent use after initial treatment.

Certain groups of individuals, including Blacks, Latinos, women, and people with substance abuse disorders, were more likely to stop taking the HIV-prevention therapy, pre-exposure prophylaxis (PrEP), a recent study revealed.

In the study published in JAMA Network Open, researchers reviewed data from 13,906 members of Kaiser Permanente in Northern California who were referred for PrEP therapy between 2012 and 2019. PrEP treatments include Gilead Sciences’ Truvada (emtricitabine/tenofovir disoproxil) and Descovy (emtricitabine/tenofovir alafenamide).

While there was strong adherence soon after patients received their PrEP prescriptions, there is less consistent use thereafter, particularly among high-priority groups such as young people, Black and Latino individuals, women, and people with substance use disorders, Kaiser Permanente said in a press release.

Most patients referred for HIV prevention care received a prescription for PrEP (88%), and nearly all (98%) of them filled their initial prescriptions, the researchers found.

However, about half of users discontinued PrEP medication at least once, and 60% of those who discontinued later filled a prescription again. “This analysis did not look at why users stopped or restarted the drugs…and some users may have discontinued PrEP because of a decrease in risk for HIV acquisition,” Kaiser Permanente said.

However, prior studies have documented medical mistrust, stigma, homophobia, and transphobia as barriers to PrEP uptake and persistence in some communities.

“We know cost can be a big concern for some people, and this study included a time period before PrEP-related services were provided at no cost as a result of changes in recommendations by the U.S. Preventive Services Task Force,” lead author J. Carlo Hojilla, RN, Ph.D., said in a statement. He is a postdoctoral research fellow in the Drug Abuse Treatment and Services Research Training Program at the University of California San Francisco and a research fellow with the Kaiser Permanente in Northern California Division of Research.

The findings suggest that targeted strategies are needed to support use of PrEP in groups at increased risk for HIV acquisition, Hojilla said. “The findings have important implications that suggest access to health care is a great way to get people in the door, but we need more effective strategies for making sure people who have an ongoing need for PrEP stay on the medication,” Hojilla said.

“These are groups we want to reach, and we need innovative approaches to keep them engaged in PrEP care,” Hojilla added.

The study was funded by a Kaiser Permanente Community Benefit research grant and the National Institutes of Health.