Understanding PrEP Persistence: Provider and Patient Perspectives

Abstract

PrEP persistence, or PrEP use over time, has been shown to be short, with most PrEP users stopping within 6–12 months. Furthermore, those most vulnerable to HIV often use PrEP for shorter periods. This qualitative study explores patient, provider, and contextual factors that influence PrEP persistence. In interviews with 25 PrEP users and 18 PrEP providers in San Francisco’s safety net clinics, we analyze the perceived benefits and difficulties of taking PrEP, including structural barriers. We identify different steps in receipt of PrEP care (clinic visits and lab tests, pharmacy interactions, and medication adherence), and describe barriers and facilitators for providers and patients at each step. Our findings suggest that drop-in visits, streamlined testing, standing orders for labs, and 90-day PrEP prescriptions are highly desirable for many PrEP users. Also important are the proactive provision of adherence support and counseling, and referrals for housing, substance use, and mental health services.

Reusmen

Se ha demostrado que la persistencia de PrEP, o el uso de PrEP a lo largo del tiempo, es corto, y la mayoría de los usuarios de PrEP lo deja de tomar dentro de 6-12 meses. Además, muchas veces las personas más vulnerables al VIH usan PrEP por períodos más cortos. Este estudio cualitativo explora pacientes, proveedores y factores contextuales que influyen en la persistencia de PrEP. En entrevistas con 25 usuarios de PrEP y 18 proveedores de PrEP en las clínicas de redes de seguridad de San Francisco, analizamos los beneficios y las dificultades percibidos de tomar PrEP, incluidas las barreras estructurales. Identificamos diferentes pasos en la recepción de la atención de PrEP (visitas a clínicas y pruebas de laboratorio, interacciones de farmacia y adherencia a medicamentos) y describimos las barreras y facilitadores para proveedores y pacientes en cada paso. Nuestros hallazgos sugieren que las visitas directas, las pruebas simplificadas, las órdenes permanentes para los laboratorios y las recetas de PrEP de 90 días son muy deseables para muchos usuarios de PrEP. También es importante la provisión proactiva de apoyo y asesoramiento de adherencia, y referencias para vivienda, uso de sustancias y servicios de salud mental.

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Funding

This study was supported by Foundation for the National Institutes of Health (R01AI104309).

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Correspondence to Nicole D. Laborde.

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Laborde, N.D., Kinley, P.M., Spinelli, M. et al. Understanding PrEP Persistence: Provider and Patient Perspectives. AIDS Behav 24, 2509–2519 (2020). https://doi.org/10.1007/s10461-020-02807-3

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Keywords

  • HIV Prevention
  • PrEP
  • Persistence