Geographic variations of PrEP reversal and abandonment among US counties

Abstract

Objective: In the United States (US), 1 in 5 newly insurer-approved pre-exposure prophylaxis (PrEP) prescriptions are reversed with over 70% of those reversed, being abandoned. Given the Ending the HIV Epidemic (EHE) initiative's goals, we assessed geographic variations of PrEP reversal and abandonment across EHE and non-EHE counties in the US. Design: This was a cross-sectional analysis of secondary data. Methods: Data were collected from Symphony Analytics for adults ≥18 years old, with a newly prescribed PrEP claim. Using the proportion of PrEP prescriptions by county, hotspot analysis was conducted utilizing Getis Ord Gi∗ statistics stratified by EHE and non EHE counties. Multivariable logistic regression was used to identify factors associated with residing in hotspots of PrEP reversal or PrEP abandonments. Results: Across 516 counties representing 36,204 patients, the overall PrEP reversal rate was 19.4%, while the PrEP abandonment rate was 13.7%. Reversals and abandonments were higher for non-EHE (22.7% and 17.1%) than EHE (15.6% and 10.5%) counties. In both EHE and non-EHE counties, younger age, less education, females, and an out-of-pocket cost of >$100, were significantly associated with greater likelihood of residing in hotspots of PrEP reversal or abandonment, while Hispanics, Medicaid recipients, and an out-of-pocket cost of ≤$10 had lower likelihood of residing in hotspots of reversal and abandonment. Conclusions: Findings indicate the need for implementation of focused interventions to address disparities observed in PrEP reversal and abandonment. Moreover, to improve primary PrEP adherence, national PrEP access programs should streamline and improve PrEP accessibility across different geographic jurisdictions.