AIDS and Behavior

, Volume 23, Issue 7, pp 1797–1802 | Cite as

PrEP in the Real World: Predictors of 6-Month Retention in a Diverse Urban Cohort

  • Alexander J. Lankowski
  • Cedric H. Bien-GundEmail author
  • Viraj V. Patel
  • Uriel R. Felsen
  • Richard Silvera
  • Oni J. Blackstock
Original Paper


The effectiveness of HIV pre-exposure prophylaxis (PrEP) depends on adherence, which requires retention in PrEP care. We sought to examine factors associated with six-month retention in PrEP care among individuals prescribed PrEP between 2011 and 2015 in a large, academic health system in the Bronx, New York. We used multivariable logistic regression to identify factors independently associated with six-month retention. Among 107 patients, retention at 6 months was 42%. In the multivariable analysis, heterosexual individuals were less likely to be retained in PrEP care at 6 months, but individuals who received prescriptions from attending physicians were more likely to be retained in care. Larger prospective studies are needed to better evaluate the individual and health system factors associated with long-term engagement in PrEP care.


HIV prevention PrEP Retention in care Implementation 


La efectividad de la Profilaxis de Pre-Exposición para el VIH (PrEP) depende de la adherencia, la cual requiere retención en el cuidado de PrEP. Buscamos examinar los factores asociados con la retención durante seis meses en el cuidado de PrEP, entre las personas a las cuales se les recetó PrEP entre los años 2011 y 2015 en un amplio sistema académico de salud en el Bronx, Nueva York. Utilizamos análisis de regresión logística multivariada para identificar los factores independientemente asociados con seis meses de retención. Entre 107 pacientes, la retención a los seis meses fue del 42%. En el análisis multivariado, las personas que se identificaron como heterosexuales fueron menos propensas a estar recibiendo el cuidado de PrEP a los seis meses, pero las que recibieron su receta de parte de los médicos asistentes tuvieron más probabilidad de retención en el cuidado de PrEP. Se necesitan estudios prospectivos más amplios para evaluar mejor los factores individuales y del sistema de salud asociados con la participación a largo plazo en el cuidado de PrEP.

Palabras clave

prevención del VIH PrEP retención en cuidado implementación 



This work was supported in part by the Einstein-Rockefeller-CUNY Center for AIDS Research funded by the National Institutes of Health (P30-AI-051519). Viraj Patel is supported by K23-MH102118, Uriel Felsen is supported by K23-MH106386, and Oni Blackstock is supported by K23-MH102129.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. For this type of study formal consent is not required.


  1. 1.
    Fonner VA, Dalglish SL, Kennedy CE, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973–83.CrossRefGoogle Scholar
  2. 2.
    Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Recommendations for HIV Prevention with Adult and Adolescents with HIV in the United States, 2014. Retrieved from Accessed Oct 11, 2017.
  4. 4.
    Volk JE, Marcus JL, Phengrasamy T, et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clin Infect Dis. 2015;61(10):1601–3.CrossRefGoogle Scholar
  5. 5.
    Marcus JL, Hurley LB, Hare CB, et al. Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and discontinuation. J Acquir Immune Defic Syndr. 2016;73(5):540–6.CrossRefGoogle Scholar
  6. 6.
    Bien CH, Patel VV, Blackstock OJ, et al. Reaching key populations: PrEP uptake in an urban health care system in the Bronx, New York. AIDS Behav. 2017;21(5):1309–14.CrossRefGoogle Scholar
  7. 7.
    Blackstock OJ, Moore BA, Berkenblit GV, et al. A cross-sectional online survey of HIV pre-exposure prophylaxis adoption among primary care physicians. J Gen Intern Med. 2017;32(1):62–70.CrossRefGoogle Scholar
  8. 8.
    New York City Department of Health and Mental Hygiene. HIV Surveillance Annual Report, 2016. Retrieved from Accessed Jan 25, 2018.
  9. 9.
    Montgomery MC, Oldenburg CE, Nunn AS, et al. Adherence to pre-exposure prophylaxis for HIV prevention in a clinical setting. PLoS ONE. 2016;11(6):e0157742.CrossRefGoogle Scholar
  10. 10.
    Chan PA, Mena L, Patel R, et al. Retention in care outcomes for HIV pre-exposure prophylaxis implementation programmes among men who have sex with men in three US cities. J Int AIDS Soc. 2016;19(1):20903.CrossRefGoogle Scholar
  11. 11.
    Liu AY, Cohen SE, Vittinghoff E, et al. HIV pre-exposure prophylaxis integrated with municipal and community based sexual health services. JAMA Intern Med. 2016;176(1):75–84.CrossRefGoogle Scholar
  12. 12.
    Misra K, Udeagu CC. Disparities in awareness of HIV postexposure and preexposure prophylaxis among notified partners of HIV-positive individuals, New York City 2015–2017. J Acquir Immune Defic Syndr. 2017;76(2):132–40.CrossRefGoogle Scholar
  13. 13.
    Walters SM, Rivera AV, Starbuck L, et al. Differences in awareness of pre-exposure prophylaxis and post-exposure prophylaxis among groups at-risk for HIV in New York State: New York City and Long Island, NY, 2011–2013. J Acquir Immune Defic Syndr. 2017;1(75 Suppl 3):S383s91.Google Scholar
  14. 14.
    The Lancet HIV. U = U taking off in 2017. Lancet HIV. 2017;4(11):e475.CrossRefGoogle Scholar
  15. 15.
    Fuchs JD, Stojanovski K, Vittinghoff E, et al. A mobile health strategy to support adherence to antiretroviral preexposure prophylaxis. AIDS Patient Care STDS. 2018;32(3):104–11.CrossRefGoogle Scholar
  16. 16.
    Siegler AJ, Mayer KH, Liu AY, et al. Developing and assessing the feasibility of a home-based PrEP monitoring and support program. Clin Infect Dis. 2018. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of General Internal MedicineAlbert Einstein College of MedicineBronxUSA
  2. 2.Department of Family and Social MedicineMontefiore Medical CenterBronxUSA
  3. 3.Division of Infectious DiseasesAlbert Einstein College of MedicineBronxUSA

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