Evolving drivers of preexposure prophylaxis discontinuation among US MSM, 2018-2024.

IF 2.9 2区医学 Q3 IMMUNOLOGY

AIDS Pub Date : 2026-08-06 DOI:10.1097/QAD.0000000000004593

Samuel M Jenness, Bevin Manuelpillai, Steven M Goodreau, Julia L Marcus, Eva A Enns, Irah L Lucas, Cristian Acero Martinez, Aaron J Siegler, Travis Sanchez

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引用次数: 0

Abstract

Objective: To examine temporal trends in reasons for stopping preexposure prophylaxis (PrEP) among MSM from 2018 to 2024, including how reasons co-occur and vary by demographics.

Design: Pooled repeated cross-sectional analysis of seven annual waves of the American Men's Internet Survey (AMIS), a national behavioral survey of US cisgender MSM (N = 54 612).

Methods: Among 3074 noncurrent PrEP users who reported reasons for stopping, we collapsed checklist items into six thematic categories and estimated adjusted prevalence by survey year using multivariable logistic regression with g-computation. Latent class analysis (LCA) identified subgroups with distinct discontinuation profiles.

Results: The most common reason was Altered Sexual Activity (55%), followed by Side Effects (31.6%) and Financial/Access (29.4%). After demographic adjustment, Altered Sexual Activity rose from 46.2% in 2018 to 61.2% in 2024 [adjusted odds ratio (aOR) 1.93], and Privacy/Discrimination roughly doubled from 5.6 to 11.3%, the only reason with a significant linear trend (aOR 1.14 per year; P = 0.003). Financial/Access remained stable at approximately 29% across all 7 years. LCA identified three classes: Changed Circumstances (35.1%), Structural Barriers (23.8%), and Clinical/Multi-Barrier (41.1%). Being uninsured was the strongest predictor of financial discontinuation (aOR 4.31).

Conclusions: Over 7 years of PrEP scale-up, circumstance-driven discontinuation grew increasingly dominant while stigma-related discontinuation doubled and cost barriers persisted. Three distinct discontinuation profiles argue for tailored approaches: re-engagement pathways for those whose circumstances change, financial navigation for structural barriers, and comprehensive clinical support for those experiencing multiple challenges.

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2018-2024年美国男男性接触者暴露前预防停止的演变驱动因素

目的：研究2018 - 2024年MSM停止暴露前预防（PrEP）的原因的时间趋势，包括原因如何同时发生以及因人口统计学而变化。设计：汇总重复横断面分析美国男性互联网调查（AMIS）的七次年度浪潮，这是一项针对美国顺性男男性行为的全国性调查（N = 54 612）。方法：对3074名报告停药原因的非PrEP使用者，我们将检查表项目分为6个主题类别，并使用多变量logistic回归和g计算方法估计按调查年调整的患病率。潜在类分析（LCA）确定了具有不同停药概况的亚组。结果：最常见的原因是性行为改变（55%），其次是副作用（31.6%）和经济/途径（29.4%）。经过人口调整后，性行为改变从2018年的46.2%上升到2024年的61.2%[调整比值比（aOR） 1.93]，隐私/歧视从5.6%上升到11.3%，大致翻了一番，这是唯一具有显著线性趋势的原因（aOR为1.14 /年；P = 0.003）。在所有7年中，财务/访问保持稳定在29%左右。LCA确定了三个类别：变化的环境（35.1%），结构障碍（23.8%）和临床/多重障碍（41.1%）。未投保是财务中断的最强预测因子（aOR 4.31）。结论：在PrEP扩大的7年中，环境驱动的停药越来越占主导地位，而与耻感相关的停药翻了一番，成本障碍仍然存在。三种不同的停药情况说明需要量身定制的方法：为那些环境发生变化的人提供重新参与途径，为结构性障碍提供财务导航，为那些面临多重挑战的人提供全面的临床支持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.