Insurance type affects persistence with PrEP
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More than half of people with commercial insurance who began pre-exposure prophylaxis, or PrEP, persisted with it for 12 months, compared with a third of those with Medicaid, according to findings published in Clinical Infectious Diseases.
“It is important that persons persist with PrEP during periods of time when they are at risk for acquiring HIV. Persistence in refilling prescriptions is a required first step for the PrEP users to be adherent in taking the medication,” Ya-lin A. Huang, PhD, health scientist for CDC’s Division for HIV/AIDS Prevention, told Healio. “Population-level effectiveness of PrEP requires both increasing access to, and uptake of, PrEP and improving persistence. This study reported data on PrEP persistence from a large database to provide a general sense of what is going on at the population level.”
Huang and colleagues examined data from the IBM MarketScan Research Database to identify persons aged 18 to 64 years who started PrEP between 2012 and 2017. Researchers evaluated PrEP persistence by determining how long a person continued to fill PrEP prescriptions until there was a gap in prescription refills of more than 30 days. They then estimated the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after beginning the therapy and determined patient characteristics that correlated with non-persistence.
The researchers examined these parameters in 11,807 commercially insured and 647 Medicaid-insured persons with PrEP prescriptions. Almost all patients in the commercial cohort were men (97.7%); most individuals in this cohort were aged 2544 years old (60.8%) and almost all resided in urban areas (95.2%). Patient demographics were similar in the Medicaid cohort; 77.6% of individuals were male and 63.2% were aged between 2544 years. Among PrEP users with Medicaid insurance, 282 were white (43.6%), 167 were black (25.8%) and 162 were classified as other race/ethnicity (25%), including 8 Hispanic persons.
Huang and colleagues found that commercially insured patients persisted with PrEP for a median period of 13.7 months (95% CI = 13.3-14.1), compared with 6.8 months (95% CI = 6.1-7.6) among patients with Medicaid. Female sex, younger age, residing in a rural location and black race also correlated with shorter persistence.
“Of those factors, female sex and younger age independently predicted non-persistence,” Huang told Healio.
She added that people may stop filling PrEP prescriptions because they no longer believe they are at risk for HIV, or because of social and structural barriers such as financial constraints, lack of transportation or lack of support from their family or community. Further research is needed to better understand the reasons behind these trends and the barriers that affect access, Huang noted.
“From this study, we found that persons in populations with the highest rates of HIV diagnoses, including young persons and black persons, persisted with PrEP for shorter periods of time compared with persons in other populations. A better understanding of reasons for discontinuing PrEP will inform interventions to support PrEP use by persons with [a] substantial risk of HIV acquisition,” she said. “Target approaches with efforts specifically designed for women, younger persons and persons of color are needed to address their barriers to persisting with PrEP.”
One such example is young PrEP users, who might require more frequent provider visits and more intensive counseling about adherence and persistence, Haung told Healio. - by Caitlyn Stulpin
Disclosure: Huang reports no relevant financial disclosures.
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