Patterns and Predictors of HIV Pre-Exposure Prophylaxis Discontinuation and Re-engagement in Care at a Safety-Net Healthcare Clinic in Atlanta Restricted; Files Only

Batina, Isabella (Summer 2023)

Permanent URL:


Background: The success of oral PrEP relies on sustained medication adherence and engagement in care while at risk for HIV.1,2 Periods of intermittent or final PrEP disengagement have been associated with HIV seroconversion.3 Various criteria and data sources have been used to define PrEP discontinuation, including pharmacy refill data, which has proven useful in identifying long- term discontinuations.4,5 In real-life settings, PrEP discontinuation rates were found to be higher among younger, Black, and substance-using individuals.6 Safety-net healthcare settings, like the Grady Health System PrEP Program in Atlanta, aim to enhance PrEP accessibility and address barriers to access for those at higher risk of HIV infection.7

Methods: This post-hoc analysis utilized data from the Grady Health System PrEP program to evaluate the PrEP care continuum during its initial three years. The study population consisted of patients who initiated PrEP between June 1, 2018, and March 1, 2021. PrEP initiation was defined as having at least one PrEP pharmacy prescription within the specified dates. Pharmacy refill data was used to identify PrEP discontinuation, defined as a gap exceeding 120 days without PrEP medication possession. Sociodemographic and clinical predictors of discontinuation were examined, and logistic regression models were applied to identify influential factors.

Results: The study population comprised 257 individuals, with a mean age of 33.7 years. Participants included diverse racial and ethnic backgrounds. Of all participants, 63.42% experienced at least one PrEP discontinuation, with 50.2% meeting final discontinuation criteria during the study period. Median time to re-engagement after each discontinuation was approximately 57-58 days. Multivariate analysis revealed age, unknown drug use, transgender women, heterosexual men, and negative baseline STIs to be significantly associated with PrEP discontinuation.

Conclusions: This study provides valuable insights into PrEP discontinuation patterns in a high- incidence HIV area, with a focus on racial and ethnic minority populations. Utilizing pharmacy refill data enhances our understanding of real-world PrEP utilization, guiding efforts to optimize PrEP delivery and long-term engagement in HIV prevention. To address disparities, future implementation science studies should focus on innovative strategies for reducing PrEP discontinuation in vulnerable populations.

Table of Contents

Chapter 1: Introduction  1

Chapter 2: Literature Review  3

Implications of PrEP Discontinuation on HIV Prevention  3

PrEP Discontinuation Studies in Research Settings  4 

PrEP Discontinuation Studies in Research Settings in Atlanta, Georgia  4

PrEP Discontinuation Studies in Real-life Scenarios  5

Using Pharmacy Refill Data for PrEP Discontinuation Studies 6

Chapter 3: Manuscript  8

Introduction  8

Methods  10

Study Design  10

Outcome Measures  11

Covariates  11

Statistical Analysis 12

Results  13

Baseline Demographics  13

PrEP Care Continuum  15

Factors associated with PrEP Discontinuation  17

Discussion  18

Chapter 4: Conclusions and Public Health Implications  21

References  23

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Last modified Preview image embargoed

Primary PDF

Supplemental Files