Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis.
Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis.
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DOI：
10.1016/s2352-3018(22)00030-3
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发表时间：
2022-04
期刊：
影响因子：
16.1
通讯作者：
Tang, Weiming
中科院分区：
文献类型：
--
作者：
Zhang, Jing;Li, Chunyan;Xu, Junjie;Hu, Zhili;Rutstein, Sarah E.;Tucker, Joseph D.;Ong, Jason J.;Jiang, Yongjun;Geng, Wenqing;Wright, Sarah T.;Cohen, Myron S.;Shang, Hong;Tang, Weiming
Poor persistence to oral HIV pre-exposure prophylaxis (PrEP) diminishes clinical and public health benefits. This study synthesizes evidence regarding discontinuation, adherence, and re-initiation of PrEP among geographically diverse PrEP users. We conducted a systematic review and meta-analysis evaluating studies published in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (inception to December 18, 2020). We included studies that presented data on PrEP discontinuation, defined as investigator-reported loss-to-follow-up or participant self-reported PrEP stoppage. Data were extracted and assessed for risk of bias. We used a random-effects meta-analysis to pool estimates and I-square and tau-squared to evaluate heterogeneity. This study was registered with PROSPERO (CRD42020155675) and followed PRISMA guidelines. The meta-analysis included 59 longitudinal studies (n=43,917). Forty-one percent of participants discontinued PrEP within six months (95% CI: 18.8–63.5%), with the highest rates in observational studies. Studies in Sub-Saharan Africa pooled a higher rate of discontinuation (47.5% [95% CI: 29.4–66.4%]) versus other regions (P<0.001). Studies with adherence interventions pooled a lower discontinuation rate than those without (24.7% vs. 36.7%, P=0.015). Studies of gay or bisexual men who have sex with men or transgender women (GBMSM/TGW) reported higher HIV incidence among PrEP users (>0.5/100 person-years) and marginally higher discontinuation (32.6% vs. 23.8%, P=0.096). GBMSM/TGW offered daily or non-daily dosing options had lower discontinuation rates than daily alone (21.6% vs. 31.5%, P<0.001). The pooled rate of suboptimal adherence within six months was 37.7% (95% CI: 8.4–66.9%). Among persons who discontinued PrEP, 47.3% (95% CI: 31.5%−63.2%) re-initiated PrEP within a year of PrEP initiation. Seventy percent of PrEP users stopped or had suboptimal adherence within six months of initiation. Among those who discontinued, fifty percent restarted PrEP later. Strategies to encourage re-initiating PrEP for new or persistent risk should be a focus of future PrEP implementation strategies. NIH and NSFC
