Long-term HIV Pre-exposure Prophylaxis Trajectories Among Racial & Ethnic Minority Patients: Short, Declining, & Sustained Adherence

J Acquir Immune Defic Syndr. 2022 Feb 1;89(2):166-171. doi: 10.1097/QAI.0000000000002833.


Background: HIV pre-exposure prophylaxis (PrEP) requires continued use at an effective dosage to reduce HIV incidence. Data suggest early PrEP drop-off among many populations. We sought to describe PrEP use over the first year among racial and ethnic minority patients in the US.

Setting: Racial and ethnic minority patients initiating PrEP at a federally qualified health center in Chicago, IL.

Methods: Using electronic health records, we determined the adherence (≥6 weekly doses) trajectories over the first year of PrEP use and compared baseline and time-varying patient characteristics.

Results: From 2159 patients, we identified 3 PrEP use trajectories. Sustained use was the most common (40%) trajectory, followed by short use (30%) and declining use (29%). In adjusted models, younger age, Black race, as well as gender, sexual orientation, insurance status at baseline, and neighborhood were associated with trajectory assignment; within some trajectories, insurance status during follow-up was associated with odds of monthly adherence (≥6 weekly doses).

Conclusion: Among racial and ethnic minorities, a plurality achieved sustained PrEP persistence. Access to clinics, insurance, and intersectional stigmas may be modifiable barriers to effective PrEP persistence; in addition, focus on younger users and beyond gay, cismale populations are needed.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-HIV Agents* / therapeutic use
  • Ethnic and Racial Minorities
  • Ethnicity
  • Female
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • HIV Infections* / prevention & control
  • Homosexuality, Male
  • Humans
  • Male
  • Minority Groups
  • Pre-Exposure Prophylaxis*
  • Sexual and Gender Minorities*


  • Anti-HIV Agents