P-295. Association of HIV Pre-exposure Prophylaxis (PrEP) Initiation and Persistence with Prior Visit with the PrEP Prescriber among Cisgender Women in the Bronx, NY, 2012-2023

TL;DR

The study finds that cisgender women in the Bronx are more likely to start HIV PrEP if they've seen the prescribing provider before, but prior visits don't help them stay on PrEP long-term.

Contribution

This study identifies a prior patient-provider relationship as a novel factor associated with PrEP initiation in cisgender women.

Findings

A prior visit with the PrEP-prescribing provider increases the odds of PrEP initiation by 1.97 times.

Having a partner living with HIV increases PrEP initiation odds by 2.26 times.

Prior visits with providers do not significantly affect PrEP persistence beyond three months.

Abstract

Pre-exposure prophylaxis (PrEP) is an effective, user-controlled HIV prevention strategy, but uptake and persistence are low in cisgender women (CGW) [1-8]. Providers have a crucial role in supporting PrEP use, and a preexisting patient-provider relationship may support PrEP initiation and persistence.Table 1.Factors Associated with PrEP Initiation and at least 3-month Persistence Among CGWSignificant differences in PrEP initiation (p<0.05) were observed in age group, partner living with HIV, recent STI, ED visit in year prior to prescription. Visit with PrEP-prescribing provider was significantly associated with PrEP initiation (p<0.05) but not persistence at ≥ 3 months. CGW = cisgender women. ED = emergency department. ID = infectious disease. IM/FM = Internal medicine and family medicine. OB/GYN = obstetrics and gynecology. PLWHIV = partner living with HIV. PrEP = preexposure prophylaxis. STI = sexually transmitted infection.Table 2.Multivariate Logistic Regression Models Evaluating an Association of PrEP Initiation and at least 3 Months of Persistence in CGW with a Visit with PrEP Prescriber in the Year Prior to PrescriptionPrEP initiation was significantly associated with a visit with the PrEP-prescribing provider in the year prior to prescription (p=0.02) and prescription by the ID department (p<0.01). CGW = cisgender women. CI = confidence interval. ID = infectious disease. IM/FM = internal medicine and family medicine. OB/GYN = obstetrics and gynecology. OR = odds ratio. PrEP = preexposure prophylaxis.

Factors Associated with PrEP Initiation and at least 3-month Persistence Among CGW

Significant differences in PrEP initiation (p<0.05) were observed in age group, partner living with HIV, recent STI, ED visit in year prior to prescription. Visit with PrEP-prescribing provider was significantly associated with PrEP initiation (p<0.05) but not persistence at ≥ 3 months. CGW = cisgender women. ED = emergency department. ID = infectious disease. IM/FM = Internal medicine and family medicine. OB/GYN = obstetrics and gynecology. PLWHIV = partner living with HIV. PrEP = preexposure prophylaxis. STI = sexually transmitted infection.

Multivariate Logistic Regression Models Evaluating an Association of PrEP Initiation and at least 3 Months of Persistence in CGW with a Visit with PrEP Prescriber in the Year Prior to Prescription

PrEP initiation was significantly associated with a visit with the PrEP-prescribing provider in the year prior to prescription (p=0.02) and prescription by the ID department (p<0.01). CGW = cisgender women. CI = confidence interval. ID = infectious disease. IM/FM = internal medicine and family medicine. OB/GYN = obstetrics and gynecology. OR = odds ratio. PrEP = preexposure prophylaxis.

A cohort of CGW at Montefiore Medical Center (MMC) receiving a PrEP prescription from July 2012, to July 2023 was identified from the Einstein-Rockefeller-CUNY Center for AIDS Research Clinical Cohort Database using a validated algorithm and by manual review of the electronic health record (EHR) [9]. PrEP initiation was defined as documentation of starting PrEP after prescription and PrEP persistence as documentation of continued PrEP use at 3, 6, and/or 12 months. Participants with no visit at MMC 12 months following prescription (n=60) and no documentation of PrEP initiation (n=66) were excluded. Chi-squared tests evaluated bivariate associations. Multivariate logistic regression models included age, partner HIV status and other statistically significant variables to evaluate if a visit with the PrEP prescriber the year prior to prescription was associated with PrEP initiation or persistence.

Of 502 CGW with PrEP prescriptions, 285 (57%) initiated PrEP, 119 (24%) continued PrEP at 3 months, 87 (17%) at 6 months and 54 (11%) at 12 months. Most of the included 376 CGW were Black (77%, 153/199) and/or Hispanic (54%, 185/342) (Table 1). A visit with the prescribing provider in the year prior was associated with 1.97 times the odds of initiating PrEP (95% CI 1.11 - 3.49, p=0.02) but not with persistence (aOR=0.94, 95% CI 0.59 - 1.50, p=0.79) (Table 2). Having a partner living with HIV was associated with 2.26 times the odds of initiation (95% CI 1.27 - 4.00, p< 0.01) but not persistence (aOR 1.54, 95% CI 0.93 - 2.53, p=0.09).

PrEP initiation is higher among CGW who had a visit with the prescribing provider in the year prior, suggesting that knowing the prescribing provider could support PrEP uptake. Additional research is needed to better understand the patient-provider relationship dynamics to develop interventions to support PrEP use for CGW.

All Authors: No reported disclosures

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