Utilisation of pre-exposure prophylaxis (PrEP) for HIV prevention in the Australian general practice setting: a longitudinal observational study

Kendal Chidwick; Allan Pollack; Doreen Busingye; Sarah Norman; Andrew Grulich; Benjamin Bavinton; Rebecca Guy; Nick Medland

doi:10.1071/SH21207

RESEARCH ARTICLE (Open Access)

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Utilisation of pre-exposure prophylaxis (PrEP) for HIV prevention in the Australian general practice setting: a longitudinal observational study

Kendal Chidwick

^A ^* , Allan Pollack ^A , Doreen Busingye ^A , Sarah Norman ^A , Andrew Grulich ^B , Benjamin Bavinton ^B , Rebecca Guy ^B and Nick Medland ^B

+ Author Affiliations

- Author Affiliations

^A NPS MedicineWise, Level 7/418A Elizabeth Street, Surry Hills, NSW 2010, Australia.

^B The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia.

^* Correspondence to: kchidwick@nps.org.au

Handling Editor: Eric Chow

Sexual Health 19(2) 101-111 https://doi.org/10.1071/SH21207
Submitted: 21 October 2021 Accepted: 3 March 2022 Published: 26 April 2022

© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background: Pre-exposure prophylaxis (PrEP) became available through the Australian Pharmaceutical Benefits Scheme (PBS) on 1 April 2018 for HIV infection prevention in patients ≥18 years at medium-to-high HIV risk. The aims were to investigate PrEP utilisation in general practice since PBS listing, and factors associated with discontinuation.

Methods: This longitudinal study included patients aged 18–74 years attending general practices participating in MedicineInsight, a large-scale national primary care database of deidentified electronic health records, between October 2017 and September 2019.

Results: PrEP utilisation increased 10-fold following PBS listing. On average, patients had 9.7 PrEP prescriptions per year; a medication possession ratio of 80.8%. Of 1552 patients prescribed PrEP from April 2018, most were male (98.3%), aged 18–39 years (59.3%), resided in major cities (86.7%) and in the two most socioeconomically advantaged quintiles (70.0%). Almost half (49.1%) of the patients were identified as new to PrEP. At study end, 65.1% were on active PrEP (16.5%, of whom had non-continuous use), 19.2% had discontinued PrEP and 15.7% were lost to follow up. Patients who discontinued were more likely to attend low rather than high PrEP caseload practices (adjusted odds ratio [aOR] 1.7; 95% CI: 1.0–2.8; P = 0.047). The odds of non-continuous therapy was 2.9-fold higher in patients with bipolar disorder (aOR 2.89; 95% CI: 1.10–7.6; P = 0.045).

Conclusions: Following PBS listing, PrEP utilisation increased and stopping therapy was associated with attending low caseload practices. General practice education, particularly among low caseload practices, could help address these disparities.

Keywords: electronic health records, emtricitabine, general practice, MedicineInsight, pharmacoepidemiology, primary health care, prophylaxis, tenofovir disoproxil fumarate drug combination.

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