{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T01:20:41Z","timestamp":1778635241340,"version":"3.51.4"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"State of Israel Ministry of Health Medical Research Fund"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>HIV Pre-exposure prophylaxis (PrEP) is the regular use of antiretroviral medication by people who are not infected with HIV to prevent seroconversion. Israel approved PrEP for continuous use in 2017, and Israeli Health Maintenance Organizations (HMO) offered PrEP with a copayment to eligible members.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methodology<\/jats:title><jats:p>This retrospective cohort study included all people who were dispensed PrEP between September 2017 to June 2019 in the second largest HMO in Israel. Statistical analysis, including Kaplan Meier, was conducted to evaluate user PrEP purchase, adherence to medical follow-up, and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>In total, a cohort of 757 PrEP users were followed for 657.8 person-years. All but one user were male; median age was 35 years. At baseline, 0.8% had gonorrhea and 1.5% had chlamydia infections and 4.4% had recent syphilis infection. Continuous use of PrEP (without interruption\/discontinuation) was observed in 29.9%, while 39.9% interrupted and 30.3% discontinued use. Median time to first interruption\/discontinuation was 4.0 months. At 6\u201312 months after initiation, 79.8% of users had a documented HIV test, 77.3% a Chlamydia-Gonorrhea panel, and 78.9% a creatinine test. There was one new case of HIV among the cohort, five months after PrEP discontinuation. Estimated first-year infection rates were 5.0%, 8.6% and 6.8% for gonorrhea, chlamydia and first-time syphilis, respectively.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>This study shows heterogeneous PrEP purchase patterns and required medical follow-up, and an increase in STIs among consistent PrEP users. Improving adherence to recommended medical follow-up during PrEP use is essential in PrEP\u2019s integration into Israel\u2019s national HIV prevention strategy.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0259168","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T18:58:54Z","timestamp":1637261934000},"page":"e0259168","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2864-9982","authenticated-orcid":true,"given":"Daniel","family":"Chemtob","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"Weil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Hannink Attal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elias","family":"Hawila","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enav","family":"Noff Sadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"issue":"27","key":"pone.0259168.ref001","first-page":"2587","article-title":"Preexposure chemoprophylaxis","volume":"363","author":"R Grant","year":"2010","journal-title":"N Engl J Med"},{"key":"pone.0259168.ref002","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1056\/NEJMoa1506273","article-title":"On- demand Preexposure prophylaxis in men at high risk for HIV-1 infection","volume":"373","author":"J Mollina","year":"2015","journal-title":"N Engl J Med"},{"issue":"387","key":"pone.0259168.ref003","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0140-6736(15)00056-2","article-title":"Pre- exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial","volume":"6","author":"S McCormack","year":"2016","journal-title":"Lancet"},{"key":"pone.0259168.ref004","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1056\/NEJMoa1108524","article-title":"Antiretroviral prophylaxis for HIV prevention in heterosexual men and women","volume":"367","author":"JM Baeten","year":"2012","journal-title":"N Engl J Med"},{"key":"pone.0259168.ref005","unstructured":"World Health Organization. Guidance on pre-exposure oral prophylaxis (PrEP) for sero-discordant couples, men, and transgender women who have sex with men at high risk for HIV. Geneva; 2012."},{"issue":"17","key":"pone.0259168.ref006","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.1097\/QAD.0000000000001983","article-title":"Increasing prevalence of self-reported HIV preexposure prophylaxis use in published surveys","volume":"32","author":"E Kamitani","year":"2018","journal-title":"AIDS"},{"key":"pone.0259168.ref007","doi-asserted-by":"crossref","first-page":"21103","DOI":"10.7448\/IAS.19.7.21103","article-title":"PrEP in Europe\u2014expectations, opportunities and barriers","volume":"19","author":"SM McCormack","year":"2016","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pone.0259168.ref008","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/QAI.0b013e3181e8efe4","article-title":"Packaging PrEP to prevent HIV: An integrated framework to plan for pre-exposure prophylaxis implementation in clinical practice","volume":"55","author":"K Underhill","year":"2010","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"pone.0259168.ref009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1758-2652-13-13","article-title":"Sex frequency and sex planning among men who have sex with men in Bangkok, Thailand: Implications for pre- and post-exposure prophylaxis against HIV infection","volume":"13","author":"F Van Griensven","year":"2010","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pone.0259168.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-019-7000-1","article-title":"HIV infection among men who have sex with men in Israel: A 35-year epidemiological and clinical overview, 1981\u20132015","volume":"19","author":"D Chemtob","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0259168.ref011","article-title":"Israel Ministry of Health. Department of Tuberculosis and AIDS","author":"D Chemtob","year":"2019","journal-title":"Annual Epidemiological Report on HIV\/AIDS in Israel, 2018"},{"issue":"1","key":"pone.0259168.ref012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-020-8334-4","article-title":"Cost utility analysis of HIV pre exposure prophylaxis among men who have sex with men in Israel","volume":"20","author":"GM Ginsberg","year":"2020","journal-title":"BMC Public Health"},{"key":"pone.0259168.ref013","unstructured":"Israel Ministry of Health Pharmacological Division. Information Packet for Medical Professionals Concerning the Use of HIV Pre-Exposure Prophylaxis. 2017;Hebrew:1\u20135."},{"key":"pone.0259168.ref014","unstructured":"Maccabi Health Services. Guidelines for PrEP Prescription. 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A Systematic Review of Observational Studies","volume":"45","author":"A Tsoumanis","year":"2018","journal-title":"Sex Transm Dis"},{"issue":"S6","key":"pone.0259168.ref027","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/jia2.25351","article-title":"Give PrEP a chance: moving on from the \u201crisk compensation\u201d concept","volume":"22","author":"D Rojas Castro","year":"2019","journal-title":"J Int AIDS Soc"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,12]],"date-time":"2023-11-12T21:11:12Z","timestamp":1699823472000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259168"}},"subtitle":[],"editor":[{"given":"Shui Shan","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,18]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0259168","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,18]]}}}