Impact of Depression at HIV PrEP Initiation on Sustained PrEP Care Engagement Among US Gay and Bisexual Men

The effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV depends on consistent use, particularly during periods of increased risk. Depression, which disproportionately affects gay, bisexual, and other men who have sex with men (GBMSM), may hinder sustained PrEP engagement. This study examines how depression impacts consistent PrEP use among GBMSM in the first 18 months after initiating oral PrEP.

We analyzed electronic health records for adult GBMSM prescribed oral PrEP between January 2015 and February 2022 at three clinics in Boston, MA. Participants were followed for 18 months after initial prescriptions, tracking three outcomes: temporary prescription gaps (interruptions in received prescriptions), dropping out of current PrEP care (cessation of prescriptions) and HIV seroconversion. Associations between baseline depression diagnosis and these outcomes were estimated using subdistribution and cause-specific Cox proportional hazards regression models.

Among 8,077 GBMSM prescribed oral PrEP, 19% had a baseline depression diagnosis. Of these, 41% experienced gaps, 38% dropped out, and 0.4% seroconverted without a prior gap. Depression was modestly associated with higher rates of PrEP disruptions (Prescription gaps: Adjusted hazard ratio [aHR] 1.10 [95% CI: 1.00, 1.20]; Dropping out: aHR 1.16 [95% CI: 1.05, 1.28]) after adjusting for age, race/ethnicity, urbanicity, high-risk sexual behavior, poverty, and bacterial STI diagnoses. However, it did not significantly impact the cumulative incidence of PrEP interruptions.

Although depression's impact on PrEP use was modest, integrating mental health care into PrEP programs remains essential for improving engagement and supporting sustained use among GBMSM.