Racial and ethnic differences in HIV pre-exposure prophylaxis reversal and abandonment in the United States

Daily oral pre-exposure prophylaxis (PrEP) effectively reduces HIV infection risks. However, adherence has been suboptimal across the United States (US), particularly among African Americans and Hispanic populations. We assessed racial and ethnic differences in PrEP primary non-adherence using two pharmacy-based measures: PrEP reversal (failure to pick up the first insurance-approved prescription) and PrEP abandonment (a reversed prescription not picked up within 365 days). Data from 2015 to 2019 were obtained from Symphony HealthCare Analytics, which covers approximately 75% of US PrEP claims. We analyzed PrEP reversal and abandonment rates among newly prescribed Black (non-Hispanic), White (non-Hispanic), and Hispanic adults using logistic regression with predicted margins to estimate unadjusted and adjusted rates. Among N = 21,653 adults, reversal rates were 23% for Black, and 19% for White and Hispanic, while abandonment rates were 17% for Black, 13% for White, and 12% for Hispanics. Across several sociodemographic characteristics, Black adults had higher unadjusted reversal and abandonment rates than White adults. Conversely, abandonment rates were lower in Hispanic compared to White adults. Lastly, after controlling for sociodemographic characteristics, no significant assoications were found. The study suggests that factors other than race, including socioeconomic and structural determinants, may drive disparities in PrEP primary non-adherence.