Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records
Abstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been government subsidized in Australia since April 2018 and while uptake is high among men who have sex with men, rates of discontinuation are also high. The aims of this study were to examine the impact of discontinuation on overall PrE...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26056 |
| _version_ | 1811176461765181440 |
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| author | Nicholas Andrew Medland Doug Fraser Benjamin R. Bavinton Fengyi Jin Andrew E. Grulich Heath Paynter Rebecca Guy Hamish McManus |
| author_facet | Nicholas Andrew Medland Doug Fraser Benjamin R. Bavinton Fengyi Jin Andrew E. Grulich Heath Paynter Rebecca Guy Hamish McManus |
| author_sort | Nicholas Andrew Medland |
| collection | DOAJ |
| description | Abstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been government subsidized in Australia since April 2018 and while uptake is high among men who have sex with men, rates of discontinuation are also high. The aims of this study were to examine the impact of discontinuation on overall PrEP usage, the proportion of PrEP users who discontinue and the predictors of discontinuation. Methods We used linked de‐identified dispensing records of all government subsidized PrEP in Australia between April 2018 and September 2021: a whole‐of‐population data set. Defining discontinuation as 180 days or more without PrEP after the final dispensed supply, we calculated the number of people who discontinued at each 6‐month interval during the study period, the proportion who had discontinued 2 years after the first supply and, using Cox regression, predictors of discontinuation. Results Of 49,164 people dispensed PrEP (98.5% male, median age 34 years), 40.3% (19,815) had discontinued by September 2021. Within 2 years of their first supply, 11,150 (37.7%) of 29,549 PrEP users had discontinued, including 10.0% after a single dispensed supply. Large variations were observed, particularly according to prescriber characteristics: discontinuation was higher among people prescribed PrEP by low caseload (≤10 patients) prescribers (61.2%) than by high caseload (>100 patients) prescribers (31.1%, p<0.001), and by prescribers practising in areas with low estimated prevalence (<1.0%) of gay men (64.1%) than high (>5%) prevalence (36.7%, p<0.001). Women and younger people were more likely to discontinue, while patients receiving a higher level of government subsidy were less likely. The independent predictors of discontinuation with the greatest effect size were female sex (adjusted hazards ratio [aHR] 2.99, p<0.001), low estimated gay prevalence of prescriber location (aHR 1.98, p<0.001) and low prescriber PrEP caseload (aHR 1.79, p<0.001). Conclusions There are high rates of PrEP discontinuation in Australia and some populations are at increased risk of discontinuation. Strategies are needed to support persistence on PrEP and the re‐starting of PrEP during periods of risk. |
| first_indexed | 2024-04-10T19:51:54Z |
| format | Article |
| id | doaj.art-9264ed21ca6f408dbfd47097037d50e3 |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-04-10T19:51:54Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-9264ed21ca6f408dbfd47097037d50e32023-01-28T02:15:32ZengWileyJournal of the International AIDS Society1758-26522023-01-01261n/an/a10.1002/jia2.26056Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing recordsNicholas Andrew Medland0Doug Fraser1Benjamin R. Bavinton2Fengyi Jin3Andrew E. Grulich4Heath Paynter5Rebecca Guy6Hamish McManus7Kirby Institute University of New South Wales Sydney New South Wales AustraliaKirby Institute University of New South Wales Sydney New South Wales AustraliaKirby Institute University of New South Wales Sydney New South Wales AustraliaKirby Institute University of New South Wales Sydney New South Wales AustraliaKirby Institute University of New South Wales Sydney New South Wales AustraliaAustralian Federation of AIDS Organisations Sydney New South Wales AustraliaKirby Institute University of New South Wales Sydney New South Wales AustraliaKirby Institute University of New South Wales Sydney New South Wales AustraliaAbstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been government subsidized in Australia since April 2018 and while uptake is high among men who have sex with men, rates of discontinuation are also high. The aims of this study were to examine the impact of discontinuation on overall PrEP usage, the proportion of PrEP users who discontinue and the predictors of discontinuation. Methods We used linked de‐identified dispensing records of all government subsidized PrEP in Australia between April 2018 and September 2021: a whole‐of‐population data set. Defining discontinuation as 180 days or more without PrEP after the final dispensed supply, we calculated the number of people who discontinued at each 6‐month interval during the study period, the proportion who had discontinued 2 years after the first supply and, using Cox regression, predictors of discontinuation. Results Of 49,164 people dispensed PrEP (98.5% male, median age 34 years), 40.3% (19,815) had discontinued by September 2021. Within 2 years of their first supply, 11,150 (37.7%) of 29,549 PrEP users had discontinued, including 10.0% after a single dispensed supply. Large variations were observed, particularly according to prescriber characteristics: discontinuation was higher among people prescribed PrEP by low caseload (≤10 patients) prescribers (61.2%) than by high caseload (>100 patients) prescribers (31.1%, p<0.001), and by prescribers practising in areas with low estimated prevalence (<1.0%) of gay men (64.1%) than high (>5%) prevalence (36.7%, p<0.001). Women and younger people were more likely to discontinue, while patients receiving a higher level of government subsidy were less likely. The independent predictors of discontinuation with the greatest effect size were female sex (adjusted hazards ratio [aHR] 2.99, p<0.001), low estimated gay prevalence of prescriber location (aHR 1.98, p<0.001) and low prescriber PrEP caseload (aHR 1.79, p<0.001). Conclusions There are high rates of PrEP discontinuation in Australia and some populations are at increased risk of discontinuation. Strategies are needed to support persistence on PrEP and the re‐starting of PrEP during periods of risk.https://doi.org/10.1002/jia2.26056discontinuationHIVpre‐exposure prophylaxispreventiondispensingretention |
| spellingShingle | Nicholas Andrew Medland Doug Fraser Benjamin R. Bavinton Fengyi Jin Andrew E. Grulich Heath Paynter Rebecca Guy Hamish McManus Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records Journal of the International AIDS Society discontinuation HIV pre‐exposure prophylaxis prevention dispensing retention |
| title | Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records |
| title_full | Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records |
| title_fullStr | Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records |
| title_full_unstemmed | Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records |
| title_short | Discontinuation of government subsidized HIV pre‐exposure prophylaxis in Australia: a whole‐of‐population analysis of dispensing records |
| title_sort | discontinuation of government subsidized hiv pre exposure prophylaxis in australia a whole of population analysis of dispensing records |
| topic | discontinuation HIV pre‐exposure prophylaxis prevention dispensing retention |
| url | https://doi.org/10.1002/jia2.26056 |
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