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Area of Science:

  • Public Health
  • Infectious Disease Prevention
  • Clinical Trial Analysis

Background:

  • Effective use of pre-exposure prophylaxis (PrEP) relies on sustained engagement in care.
  • The United States PrEP Demonstration Project evaluated daily oral tenofovir/emtricitabine over 48 weeks.

Purpose of the Study:

  • To analyze retention patterns in the US PrEP Demonstration Project.
  • To identify demographic and behavioral factors associated with loss to follow-up and intermittent retention in PrEP care.

Main Methods:

  • Categorized participants into early loss to follow-up (ELTF), intermittent retention, or full retention.
  • Utilized two-step multivariable analysis to assess baseline characteristics and retention patterns.

Main Results:

  • 66.1% achieved full retention, 22.9% had intermittent retention, and 11.0% experienced ELTF.
  • Miami site, younger age, Black race, sex work, lack of employment, and no prior PrEP awareness were associated with higher loss to follow-up or intermittent retention compared to full retention.

Conclusions:

  • Retention in PrEP care is variable, with significant proportions experiencing early or intermittent loss.
  • Targeted interventions addressing identified risk factors are essential to improve PrEP adherence and effectiveness.