HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis

Area of Science:

• Public Health
• Infectious Disease Prevention
• Clinical Pharmacy

Background:

• HIV Pre-exposure prophylaxis (PrEP) is a key biomedical intervention for HIV prevention.
• Israel approved PrEP in 2017, with Health Maintenance Organizations (HMOs) offering it via copayment.
• Understanding real-world PrEP use patterns and outcomes in Israel is crucial for public health strategies.

Purpose of the Study:

• To evaluate PrEP purchase patterns and adherence to medical follow-up.
• To assess clinical outcomes, including sexually transmitted infections (STIs) and HIV seroconversion.
• To inform the integration of PrEP into Israel's national HIV prevention strategy.

Main Methods:

• Retrospective cohort study of 757 PrEP users in Israel (September 2017 - June 2019).
• Analysis of PrEP dispensing data, medical follow-up adherence (HIV tests, STI panels, creatinine tests), and clinical outcomes.
• Kaplan-Meier survival analysis to evaluate PrEP use patterns and time to discontinuation.

Main Results:

• Continuous PrEP use was observed in 29.9% of users; 30.3% discontinued use.
• High adherence to recommended medical follow-up tests (HIV, STI, creatinine) was noted at 6-12 months.
• First-year incidence rates for gonorrhea, chlamydia, and syphilis were 5.0%, 8.6%, and 6.8%, respectively. One HIV case occurred post-discontinuation.

Conclusions:

• PrEP use patterns in Israel are heterogeneous, with significant interruption and discontinuation rates.
• An increase in STIs was observed among consistent PrEP users, highlighting the need for comprehensive prevention strategies.
• Improving adherence to medical follow-up is essential for successful PrEP implementation and HIV prevention.