Alcohol Use Disorder Diagnoses and HIV Preexposure Prophylaxis Adherence and Continuation: a Retrospective Cohort...

Area of Science:

• Public Health
• Clinical Pharmacy
• Infectious Disease Epidemiology

Background:

• Alcohol use disorder (AUD) is linked to reduced adherence and discontinuation of HIV pre-exposure prophylaxis (PrEP).
• This can compromise the effectiveness of PrEP in preventing HIV transmission.

Purpose of the Study:

• To investigate the association between AUD and PrEP adherence and continuation.
• To identify potential disparities in PrEP use among individuals with AUD.

Main Methods:

• Retrospective cohort study utilizing MarketScan Commercial Claims data.
• Included individuals aged 16-64 initiating PrEP between 2014-2021 with continuous insurance.
• AUD diagnosis identified within six months pre-PrEP initiation; adherence measured by proportion of days covered (PDC) and continuation by uninterrupted supply.

Main Results:

• Among 43,913 individuals, 2.84% had a pre-existing AUD diagnosis.
• In a matched sample, individuals with AUD had significantly lower mean PDC (59.54% vs. 65.85%) and fewer days of continuous PrEP use (107 vs. 119.90 days).
• Regression analyses confirmed AUD was associated with 6.31% lower mean PDC and 12.93 fewer days of PrEP continuity.

Conclusions:

• Pre-initiation AUD is associated with poorer PrEP adherence and continuation.
• This highlights the need for targeted interventions to support PrEP use in individuals with AUD.
• Findings may be limited to commercially insured populations.