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Alcohol Use Disorder Diagnoses and HIV Preexposure Prophylaxis Adherence and Continuation: a Retrospective Cohort
Anton L V Avanceña1,2,3, Godwin Okoye4, Rishit Yokananth5
1Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, 2409 University Ave, PHR 2.112, Austin, TX, 78712, USA. antonlv@utexas.edu.
Importance:
Alcohol use disorder (AUD) has been associated with reduced adherence to and discontinuation of HIV preexposure prophylaxis (PrEP), potentially compromising its effectiveness.
Objective:
This study examines the relationship between AUD and PrEP adherence and continuation.
Design:
Retrospective cohort study using MarketScan Commercial Claims data.
Participants:
We included individuals aged 16-64 who initiated PrEP between January 1, 2014, and December 31, 2021, and had continuous insurance coverage.
Main Measures:
AUD diagnosis was identified within six months before PrEP initiation. Adherence was measured using the proportion of days covered (PDC) over 180 days and categorized by clinically relevant thresholds (≥ 85%, ≥ 80%, ≥ 57%). Continuation was assessed based on uninterrupted PrEP supply without a ≥ 30-day gap. Statistical analyses included propensity-score matching and regression modeling.
Key Results:
Among 43,913 eligible individuals, 1,245 (2.84%) had an AUD diagnosis prior to PrEP initiation. In a matched sample of 1,153 individuals, those with AUD had lower mean PDC (59.54% [34.14] vs. 65.85% [33.18]; p < 0.001) and fewer mean days of continuous PrEP use (107 [67.20] days vs. 119.90 [65.21] days; p < 0.001) compared to the Without AUD group. Regression analyses showed individuals with AUD had 6.31% lower mean PDC (95% CI: -9.05% to -3.57%; p < 0.001) and 12.93 fewer days of PrEP continuity (95% CI: -18.34 to -7.52 days; p < 0.001) compared to the Without AUD group. Findings may not be generalizable beyond commercially insured individuals, and we may have not captured all factors that influence PrEP adherence.
Conclusion:
Individuals with AUD before PrEP initiation exhibited lower adherence and continuation compared to those without AUD. Targeted interventions may be required to enhance PrEP adherence and continuity in this population.
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