{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:54:04Z","timestamp":1791899644693,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T00:00:00Z","timestamp":1550188800000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NIMH MH098795"],"award-info":[{"award-number":["NIMH MH098795"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NIAID K01 AI122853"],"award-info":[{"award-number":["NIAID K01 AI122853"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 AI060354"],"award-info":[{"award-number":["P30 AI060354"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007301","name":"Harvard University Center for AIDS Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007301","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,2]]},"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n \n Discontinuations of\n HIV<\/jats:styled-content>\n preexposure prophylaxis (Pr\n EP<\/jats:styled-content>\n ) by at\u2010risk individuals could decrease the effectiveness of Pr\n EP<\/jats:styled-content>\n . Our objective was to characterize patterns of, reasons for, and clinical outcomes associated with Pr\n EP<\/jats:styled-content>\n discontinuations in primary care.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted medical chart reviews for patients prescribed Pr\n EP<\/jats:styled-content>\n during 2011 to 2014 at a Boston community health centre specializing in healthcare for sexual and gender minorities. Patients were followed through 2015. We characterized patients\u2019 sociodemographics, relationship status, behavioural health conditions, patterns of and reasons for Pr\n EP<\/jats:styled-content>\n discontinuations, and\n HIV<\/jats:styled-content>\n seroconversions. Cox proportional hazards models were used to assess patient factors associated with Pr\n EP<\/jats:styled-content>\n discontinuations.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 663 patients prescribed Pr\n EP<\/jats:styled-content>\n , the median age was 33\u00a0years, 96% were men who have sex with men (\n MSM<\/jats:styled-content>\n ) and 73% were non\u2010Hispanic white; 40% were in committed relationships and 15% had\n HIV<\/jats:styled-content>\n \u2010infected partners. Patients either used Pr\n EP<\/jats:styled-content>\n continuously (60%), had 1 or more discontinuations (36%), or did not initiate Pr\n EP<\/jats:styled-content>\n (4%). Discontinuations were most often due to a decrease in\n HIV<\/jats:styled-content>\n risk perception (33%), non\u2010adherence to care plans (16%), or insurance barriers (12%). Of the 7 (1.1%) Pr\n EP<\/jats:styled-content>\n patients diagnosed with\n HIV<\/jats:styled-content>\n , 1 was\n HIV<\/jats:styled-content>\n \u2010infected at baseline, 2 seroconverted while using Pr\n EP<\/jats:styled-content>\n , and 4 seroconverted after discontinuations. In a multivariable model adjusted for race\/ethnicity, relationship status, substance use disorders, and insurance status, those who were less than 30\u00a0years old (\n aHR<\/jats:styled-content>\n 2.0, 95%\n CI<\/jats:styled-content>\n 1.4 to 2.9 for ages 18 to 24,\n aHR<\/jats:styled-content>\n 2.2, 95%\n CI<\/jats:styled-content>\n 1.6 to 3.1 for ages 25 to 29, vs. ages 30 to 39\u00a0years), who identified as transgender women (\n aHR<\/jats:styled-content>\n 2.0, 95%\n CI<\/jats:styled-content>\n 1.2 to 3.4, vs. cisgender men), and who had mental health disorders (\n aHR<\/jats:styled-content>\n 1.2, 95%\n CI<\/jats:styled-content>\n 1.1 to 1.4 for each additional disorder) were more likely to have discontinuations.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Discontinuations of Pr\n EP<\/jats:styled-content>\n use among this American sample of predominately\n MSM<\/jats:styled-content>\n were common, particularly among patients who were younger, identified as transgender women, or had behavioural health issues. As\n HIV<\/jats:styled-content>\n seroconversions occurred after discontinuations of Pr\n EP<\/jats:styled-content>\n , strategies to prevent inappropriate discontinuations are needed.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jia2.25250","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T06:30:43Z","timestamp":1550212243000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":107,"title":["Patterns and clinical consequences of discontinuing\n HIV<\/scp>\n preexposure prophylaxis during primary care"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4027-472X","authenticated-orcid":false,"given":"Douglas","family":"Krakower","sequence":"first","affiliation":[{"name":"Division of Infectious Disease Beth Israel Deaconess Medical Center Boston MA USA"},{"name":"The Fenway Institute Fenway Health Boston MA USA"},{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M","family":"Maloney","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria E","family":"Powell","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease Beth Israel Deaconess Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Levine","sequence":"additional","affiliation":[{"name":"The Fenway Institute Fenway Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Grasso","sequence":"additional","affiliation":[{"name":"The Fenway Institute Fenway Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Melbourne","sequence":"additional","affiliation":[{"name":"Gilead Sciences Foster City CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia L","family":"Marcus","sequence":"additional","affiliation":[{"name":"The Fenway Institute Fenway Health Boston MA USA"},{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7460-733X","authenticated-orcid":false,"given":"Kenneth H","family":"Mayer","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease Beth Israel Deaconess Medical Center Boston MA USA"},{"name":"The Fenway Institute Fenway Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,15]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"US Centers for Disease Control and Prevention.HIV in the United States: at a glance2017[cited 2018 Dec 19]. 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