Mind the gaps: prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California : Mind the Gaps: Cobertura de recetas e incidencia de VIH entre pacientes recibiendo profilaxis pre-exposición de un centro de salud grande y federalmente calificado en Los Ángeles, CA

Chelsea L Shover; Steven Shoptaw; Marjan Javanbakht; Sung-Jae Lee; Robert K Bolan; Nicole J Cunningham; Matthew R Beymer; Michelle A DeVost; Pamina M Gorbach

doi:10.1007/s10461-019-02493-w

Mind the gaps: prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California : Mind the Gaps: Cobertura de recetas e incidencia de VIH entre pacientes recibiendo profilaxis pre-exposición de un centro de salud grande y federalmente calificado en Los Ángeles, CA

AIDS Behav. 2019 Oct;23(10):2730-2740. doi: 10.1007/s10461-019-02493-w.

Authors

Chelsea L Shover^{1

2

3}, Steven Shoptaw⁴, Marjan Javanbakht⁵, Sung-Jae Lee^{5

6}, Robert K Bolan⁷, Nicole J Cunningham⁷, Matthew R Beymer^{7

8}, Michelle A DeVost^{7

9}, Pamina M Gorbach^{5

8}

Affiliations

¹ Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA. clshover@stanford.edu.
² Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA. clshover@stanford.edu.
³ Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA. clshover@stanford.edu.
⁴ Departments of Family Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁵ Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
⁶ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁷ Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA.
⁸ Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁹ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

Abstract
in English, Spanish

We conducted a records-based cohort study of patients who initiated pre-exposure prophylaxis (PrEP) at a large federally qualified health center in Los Angeles, CA to characterize patterns of PrEP use, identify correlates of PrEP discontinuation, and calculate HIV incidence. Of 3121 individuals initiating PrEP between 2014 and 2017, 42% (n = 1314) were active (i.e., had a current PrEP prescription) in April 2018. HIV incidence was 0.1/100 person-years among active PrEP patients, compared to 2.1/100 person-years among patients who discontinued. Compared to patients accessing PrEP through government programs with no prescription copay, risk of discontinuation was higher among those with private insurance (ARR = 1.4, 95% CI 1.2, 1.7), or no insurance (ARR = 4.5, 95% CI 3.2, 6.4). Sixty-three percent of active PrEP patients had gaps between PrEP prescriptions, averaging one gap per year (median length = 65 days). Increasing access to free or low-cost PrEP can improve PrEP continuity.

Llevamos a cabo un estudio de cohorte basada en registros de pacientes quienes iniciaron profilaxis preexposición (PrEP) en un centro de salud grande y federalmente calificado en Los Ángeles, CA para caracterizar patrones del uso de PrEP, identificar correlaciones de la discontinuación de PrEP y calcular la incidencia de VIH. De los 3,121 individuos quienes iniciaron PrEP entre los años 2014–2017, 42% (n=1,314) fueron activos (i.e. actualmente tenían una receta para PrEP) en abril 2018. La incidencia de VIH fue 0.1/100 persona-años entre los pacientes activos con PrEP, comparada a 2.1/100 personas-años entre los pacientes quienes lo dejaron de usar. Comparado a los pacientes accediendo a PrEP a través de programas gubernamentales sin copago para las recetas, el riesgo de discontinuación de PrEP fue más alto entre los con seguro de salud privado (RRA = 1.4, 95% CI: 1.2, 1.7) o los que no tienen seguro de salud (RRA = 4.5, 95% CI: 3.2, 6.4). Sesenta y tres por ciento de los pacientes activos de PrEP tenían lapsos sin recetas de PrEP, con un promedio de uno lapso por año (duración del lapso mediano = 65 días). Ampliando el acceso a PrEP gratis o con bajo costo puede mejorar la continuidad de tomar PrEP.

Keywords: HIV incidence; HIV prevention; Health insurance; Pre-exposure prophylaxis.

MeSH terms

Adolescent
Adult
Aged
Anti-HIV Agents / administration & dosage
Anti-HIV Agents / economics*
Cohort Studies
Follow-Up Studies
HIV Infections / economics
HIV Infections / epidemiology*
HIV Infections / prevention & control*
Humans
Incidence
Insurance, Health*
Longitudinal Studies
Los Angeles / epidemiology
Male
Middle Aged
Pre-Exposure Prophylaxis / economics*
Pre-Exposure Prophylaxis / statistics & numerical data
Treatment Adherence and Compliance / statistics & numerical data*
Young Adult

Substances

Anti-HIV Agents

Abstract in English, Spanish

MeSH terms

Substances

Grants and funding

Abstract
in English, Spanish