Understanding why clients stop taking pre-exposure prophylaxis (PrEP) is critical to improve PrEP delivery and ultimately reduce HIV incidence. We analyzed data from a programmatic evaluation conducted at the Los Angeles LGBT Center from February to May 2018. Of 180 respondents to the emailed survey, 91 had stopped taking PrEP and 11 never started. Among former PrEP users, most common reasons for stopping were entering a monogamous relationship (43%) and side effects (40%). Ten of 11 who never started PrEP reported access barriers (e.g., cost, insurance problems). A quarter of inactive clients re-engaged with PrEP services following the survey and 15% restarted PrEP by October 2018. Improving PrEP retention may require multifaceted interventions-e.g., tailored discussions about stopping and restarting PrEP safely as HIV risk changes, ensuring consistent access to affordable PrEP, and alternative dosing strategies. An emailed survey may be a simple, effective strategy to reengage some PrEP clients.

中文翻译：

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在大型城市诊所中，影响停药前预防（PrEP）的结构，剂量和风险变化因素

了解服务对象为何停止服用暴露前预防（PrEP）对于改善PrEP的提供并最终降低HIV发病率至关重要。我们分析了2018年2月至2018年5月在洛杉矶LGBT中心进行的程序评估的数据。在通过电子邮件发送的调查的180位受访者中，有91位停止服用PrEP，11位从未开始服用。在以前的PrEP用户中，停止服用药物的最常见原因是进入一夫一妻制关系（43％）和副作用（40％）。从未启动PrEP的11人中有10人报告了访问障碍（例如，成本，保险问题）。调查后有四分之一的不活跃客户重新使用PrEP服务，到2018年10月，有15％的客户重新启动了PrEP。提高PrEP保留率可能需要多方面的干预措施，例如，针对随着HIV风险的变化安全停止和重新启动PrEP进行的专门讨论，确保始终获得负担得起的PrEP，以及其他剂量策略。通过电子邮件发送的调查可能是重新吸引某些PrEP客户的一种简单有效的策略。