TY - JOUR
T1 - Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis
T2 - a global systematic review and meta-analysis
AU - Zhang, Jing
AU - Li, Chunyan
AU - Xu, Junjie
AU - Hu, Zhili
AU - Rutstein, Sarah E.
AU - Tucker, Joseph D.
AU - Ong, Jason J.
AU - Jiang, Yongjun
AU - Geng, Wenqing
AU - Wright, Sarah T.
AU - Cohen, Myron S.
AU - Shang, Hong
AU - Tang, Weiming
N1 - Funding Information:
This work was supported by the Mega-Projects of National Science Research (13th Five-Year Plan [2017ZX10201101–002–007], 12th Five-Year Plan [2012ZX10001006–001–010], [2018ZX10101001–001–003]), National Natural Science Foundation of China (81903371, 81872674), the National Key Research and Development Program of China (2017YFE0103800), the National Institutes of Health (NIAID K24AI143471, R34MH109359, and R34MH119963), Guangdong Medical Science and Technology Research Fund (A2020509), the National Social Science Fund of China (number 19CSH018), and University of North Carolina Center for AIDS Research (P30 AI050410). SER was supported by the University of North Carolina STD/HIV training grant (T32AI007001).
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/4
Y1 - 2022/4
N2 - Background: Poor adherence to oral HIV pre-exposure prophylaxis (PrEP) diminishes its clinical and public health benefits. This study synthesises evidence regarding discontinuation, adherence, and reinitiation of PrEP among geographically diverse PrEP users. Methods: We did a systematic review and meta-analysis evaluating studies published in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to Dec 18, 2020. We included longitudinal studies that presented data for PrEP discontinuation, defined as investigator-reported loss to follow-up or participant self-reported PrEP stoppage. Data were extracted from published reports and assessed for risk of bias. We used a random-effects meta-analysis to pool estimates of discontinuation and I2 and τ2 to evaluate heterogeneity. This study is registered with PROSPERO, CRD42020155675. Findings: We identified 4129 records, of which 59 articles were included (n=43 917 participants). 41·0% (95% CI 18·8–63·5) of participants discontinued PrEP within 6 months, with the highest rates in observational studies. The discontinuation rate in sub-Saharan Africa (47·5%, 95% CI: 29·4–66·4%) was higher than in other regions (p<0·001). Discontinuation rates were lower in studies with adherence interventions than in those without (24·7% vs 36·7%, p=0·015). Gay or bisexual men who have sex with men and transgender women offered daily or non-daily dosing options had lower discontinuation rates than those offered daily dosing alone (21·6% vs 31·5%; p<0·001). The pooled suboptimal adherence within 6 months was 37·7% (95% CI 8·4–66·9). Among people who discontinued PrEP, 47·3% (95% CI 31·5–63·2) reinitiated PrEP within 1 year of PrEP initiation. The included studies had poor quality in terms of study design, with a moderate risk of bias. Interpretation: Strategies to encourage reinitiating PrEP for new or persistent risk should be a focus of future PrEP implementation strategies. Funding: National Institutes of Health and Nature Science Foundation of China.
AB - Background: Poor adherence to oral HIV pre-exposure prophylaxis (PrEP) diminishes its clinical and public health benefits. This study synthesises evidence regarding discontinuation, adherence, and reinitiation of PrEP among geographically diverse PrEP users. Methods: We did a systematic review and meta-analysis evaluating studies published in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to Dec 18, 2020. We included longitudinal studies that presented data for PrEP discontinuation, defined as investigator-reported loss to follow-up or participant self-reported PrEP stoppage. Data were extracted from published reports and assessed for risk of bias. We used a random-effects meta-analysis to pool estimates of discontinuation and I2 and τ2 to evaluate heterogeneity. This study is registered with PROSPERO, CRD42020155675. Findings: We identified 4129 records, of which 59 articles were included (n=43 917 participants). 41·0% (95% CI 18·8–63·5) of participants discontinued PrEP within 6 months, with the highest rates in observational studies. The discontinuation rate in sub-Saharan Africa (47·5%, 95% CI: 29·4–66·4%) was higher than in other regions (p<0·001). Discontinuation rates were lower in studies with adherence interventions than in those without (24·7% vs 36·7%, p=0·015). Gay or bisexual men who have sex with men and transgender women offered daily or non-daily dosing options had lower discontinuation rates than those offered daily dosing alone (21·6% vs 31·5%; p<0·001). The pooled suboptimal adherence within 6 months was 37·7% (95% CI 8·4–66·9). Among people who discontinued PrEP, 47·3% (95% CI 31·5–63·2) reinitiated PrEP within 1 year of PrEP initiation. The included studies had poor quality in terms of study design, with a moderate risk of bias. Interpretation: Strategies to encourage reinitiating PrEP for new or persistent risk should be a focus of future PrEP implementation strategies. Funding: National Institutes of Health and Nature Science Foundation of China.
UR - http://www.scopus.com/inward/record.url?scp=85127121631&partnerID=8YFLogxK
U2 - 10.1016/S2352-3018(22)00030-3
DO - 10.1016/S2352-3018(22)00030-3
M3 - Article
C2 - 35364026
AN - SCOPUS:85127121631
SN - 2405-4704
VL - 9
SP - e254-e268
JO - The Lancet HIV
JF - The Lancet HIV
IS - 4
ER -
