PrEP Outcomes in an Urban Community in North Carolina: Discontinuation of Care and Sexually Transmitted Infections.

BACKGROUND Few studies have examined long-term outcomes among persons who initiate pre-exposure prophylaxis (PrEP) in the South, including PrEP discontinuation and sexually transmitted infection (STI) rates. METHODS Care discontinuation (>6 months without a PrEP appointment) and incident STIs were evaluated for patients at two PrEP clinics in Durham, North Carolina. We tested for predictors of discontinuation as a binary variable using logistic regression. Model covariates included age, race/ethnicity, sex, known HIV-positive partner, commercial sex work, men who have sex with men [MSM] vs not MSM, type of insurance and clinic site. A similar analysis was completed for STI incidence, controlling for days in the study. RESULTS Among 271 patients, mean age was 33.2, 46.9% were Black and 11.1% were Latino; 81.2% were MSM, and 32% were uninsured. PrEP was discontinued in 47%, and another 11% had intermittent care. STI incidence was 45.4/100 person years and five patients were diagnosed with HIV at baseline or in follow-up. MSM were less likely to discontinue PrEP relative to non-MSM (OR=0.26 (95%CI=0.10-0.64). Baseline STI was associated with a higher likelihood of incident STI (OR=8.19; 95% CI= 3.69-19.21), while care discontinuation was associated with a lower likelihood of STI (OR=0.28, CI 0.11-0.65). CONCLUSIONS PrEP programs in the Southern US are reaching uninsured and predominantly Black and Latino MSM, but discontinuation rates are high despite elevated rates of incident STI and HIV. Further work is required to elucidate causes of PrEP discontinuation and encourage persistence in care.