Referral linkage to pre-exposure prophylaxis (PrEP) care and persistence on PrEP in an integrated healthcare system.

BACKGROUND Successful linkage to pre-exposure prophylaxis (PrEP) and retention in care are important for HIV prevention. We examined gaps in PrEP care following referral and factors associated with PrEP linkage and persistence in an integrated healthcare system in the United States. METHODS We identified individuals referred for PrEP from 2014-2017 at Kaiser Permanente Southern California using electronic health records and assessed linkage to care, PrEP prescription orders and fills, and PrEP persistence (medication possession ratio ≥80%) in the year after the first fill. We evaluated demographic and clinical factors potentially associated with PrEP linkage and persistence using a series of multivariable modified Poisson regression models. RESULTS Of 2,995 referred individuals, 74.9% were linked to PrEP care. Nearly all those linked to care were prescribed PrEP and filled a prescription, but only 47.4% of those who filled a prescription were persistent on PrEP. Individuals ages <25 years (vs ≥25 years), females (vs males), and individuals with high deductible insurance (vs no high deductible) were less likely to be linked to care. Individuals ages <25 years and Hispanics (vs non-Hispanic Whites) were less likely to be persistent. Those with alcohol use disorder were more likely to be linked to PrEP care, but less likely to be persistent. New HIV diagnoses occurred for 38 individuals, only 1 who had PrEP in possession at diagnosis. CONCLUSION We observed PrEP care gaps and disparities among individuals referred for PrEP. Patient-centered interventions are needed in primary care to address barriers to successful PrEP linkage and persistence.