Poor Oral HIV Pre-Exposure Prophylaxis (PrEP) Persistence in an Integrated PrEP/STI Program in Malawi.

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• HIV Prevention

Background:

• Integrating HIV pre-exposure prophylaxis (PrEP) into sexually transmitted infection (STI) services can increase uptake.
• Longitudinal PrEP use in sub-Saharan Africa, particularly within integrated services, remains understudied.
• Effective PrEP requires continuous coverage during periods of HIV risk.

Purpose of the Study:

• To analyze longitudinal PrEP use and persistence among individuals accessing PrEP through an STI clinic in Lilongwe, Malawi.
• To estimate expected PrEP persistence rates under standard-of-care services.
• To identify predictors of PrEP persistence and describe re-engagement patterns.

Main Methods:

• Analysis of routine records data from new PrEP initiators (n=662) at an STI clinic.
• Data reweighting to reflect the baseline distribution of age, sex, and PrEP indication for the full study population (n=835).
• Weighted generalized estimating equations used to estimate persistence proportions at 1, 3, and 6 months.

Main Results:

• Estimated persistence rates under standard-of-care were 17% at 1 month, 7% at 3 months, and 4% at 6 months.
• Only 8% of those not persisting at 1 month re-engaged by 12 months.
• PrEP persistence varied significantly by age and indication for PrEP use.

Conclusions:

• Findings indicate very low PrEP persistence in this population accessing integrated STI and PrEP services.
• Opportunities exist to improve ongoing PrEP use and support within these integrated service models.
• Further strategies are needed to ensure sustained PrEP coverage for effective HIV prevention.