Non-adherence, discontinuation, and seroconversion among people on daily HIV pre-exposure prophylaxis (PrEP) in Brazil: a nationwide cohort study.
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| Title: | Non-adherence, discontinuation, and seroconversion among people on daily HIV pre-exposure prophylaxis (PrEP) in Brazil: a nationwide cohort study. |
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| Authors: | Crepalde-Ribeiro, Kennedy, Braga, Maria das Graças, Silveira, Micheline Rosa, Moura, Alexandre Sampaio, Vaz-de-Melo, Pedro O.S., Ferraz, Matheus Marchesotti Dutra, Pearson, Sallie-Anne, Costa, Juliana de Oliveira |
| Source: | AIDS Care. Feb2025, Vol. 37 Issue 2, p289-299. 11p. |
| Subjects: | HIV prevention, Patient compliance, Risk assessment, HIV seroconversion, Research funding, Logistic regression analysis, Sex distribution, Seroconversion, Descriptive statistics, HIV infections, Population geography, Pre-exposure prophylaxis, Drugs, Patient refusal of treatment, Confidence intervals, Educational attainment |
| Geographic Terms: | Brazil |
| Abstract: | The goal of this study was to evaluate characteristics associated with Pre-exposure Prophylaxis for HIV infection (PrEP) non-adherence or discontinuation in Brazil and assess the association between these outcomes and HIV seroconversion. We used linked national dispensing and pathology data to identify people aged 14+ years initiating PrEP in 2018. We estimated non-adherence using the proportion of days covered (PDC), defining non-adherence as PDC < 60%. We defined discontinuation as a gap in therapy of at least 120 days. We used logistic regression models to assess characteristics associated with non-adherence or discontinuation within 365 days and to assess HIV seroconversion and its association with non-adherence or discontinuation. In 2018, 5100 people initiated PrEP; 34.4% (95%CI 33.1%; 35.7%) were non-adherent and 34.3% (95%CI 33.0%; 35.6%) discontinued. People aged 34 years or less, women, people with lower education levels, or living in the Northern region of Brazil were more likely to be non-adherent or discontinue therapy. Thirty people (0.6% 95%CI 0.4%; 0.8%) seroconverted. HIV seroconversion was associated with PrEP non-adherence or discontinuation (OR = 6.2 for both). Non-adherence and discontinuation were common in people initiating PrEP and strongly associated with HIV seroconversion. Our work identifies populations at higher risk of non-adherence or discontinuation which could be targeted in interventions to reduce new HIV cases in Brazil. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | The goal of this study was to evaluate characteristics associated with Pre-exposure Prophylaxis for HIV infection (PrEP) non-adherence or discontinuation in Brazil and assess the association between these outcomes and HIV seroconversion. We used linked national dispensing and pathology data to identify people aged 14+ years initiating PrEP in 2018. We estimated non-adherence using the proportion of days covered (PDC), defining non-adherence as PDC < 60%. We defined discontinuation as a gap in therapy of at least 120 days. We used logistic regression models to assess characteristics associated with non-adherence or discontinuation within 365 days and to assess HIV seroconversion and its association with non-adherence or discontinuation. In 2018, 5100 people initiated PrEP; 34.4% (95%CI 33.1%; 35.7%) were non-adherent and 34.3% (95%CI 33.0%; 35.6%) discontinued. People aged 34 years or less, women, people with lower education levels, or living in the Northern region of Brazil were more likely to be non-adherent or discontinue therapy. Thirty people (0.6% 95%CI 0.4%; 0.8%) seroconverted. HIV seroconversion was associated with PrEP non-adherence or discontinuation (OR = 6.2 for both). Non-adherence and discontinuation were common in people initiating PrEP and strongly associated with HIV seroconversion. Our work identifies populations at higher risk of non-adherence or discontinuation which could be targeted in interventions to reduce new HIV cases in Brazil. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 09540121 |
| DOI: | 10.1080/09540121.2024.2443824 |
