Table 5.
Clinician Reported Reasons to Discontinue PrEP
Clinician reported reasons to discontinue PrEP | N (%) | Illustrative quotations |
---|---|---|
Lack of adherence | ||
Failure to adhere to follow-up monitoring visits | 14 (93) | “If someone is really not coming in for monitoring, I wouldn't re-prescribe it.” |
Poor adherence to PrEP medication | 7 (47) | “I think if somebody was having such poor adherence that it seemed like it might not be effective, then I might say, ‘Maybe this isn't the best strategy for you, and we can work on other prevention strategies.’” |
Patient is selling or sharing PrEP medication | 3 (20) | “If they were using it very inappropriately, you know, if they were giving it to friends…sharing it.” |
Presence of a mental health or substance abuse issue that interferes with adherence | 1 (7) | “…Mental health or substance abuse. I think that any of those scenarios would be included to decide on discontinuing PrEP.” |
Patient self-discontinues PrEP | 1 (7) | “I think probably what would happen is they would just stop coming to clinic to get it and that would be where it would end.” |
Decreased risk of patient acquiring HIV | ||
Patient in a serodiscordant relationship in which the HIV- infected partner has started ART/virologically suppressed | 4 (27) | “If they're in a stable relationship and the positive partner is now having good virologic control, then I might stop PrEP in the negative person.” |
Patient has skills/power to negotiate safer sexual behavior | 3 (20) | “If the person had enough skills that he or she could negotiate safer sex techniques and be in more control over partner selection…” |
Patient is now in a monogamous relationship | 2 (13) | “And then if someone felt that their risk level was decreased, so if it was someone who had had multiple partners before who is now in a mutually monogamous relationship.” |
Patient has matured developmentally | 1 (7) | “One part would be the positive aspect where the developmental shift has occurred in an individual. They're more empowered, able to manage and negotiate barrier use, and in a sense then the benefit of Truvada® is outweighed by the risks of Truvada®.” |
Safety reasons | ||
Development of abnormal laboratory testing or toxicity (i.e. decreased bone mineral density, renal dysfunction) | 7 (47) | “And of course if there are side effects, you know, changes in bone density, or renal, or if they have any adverse effects, I'd stop prescribing it.” |
HIV seroconversion | 5 (33) | “Obviously if somebody were to seroconvert and become HIV positive, I would stop PrEP.” |
Allergic reaction to drug | 2 (13) | “You've had an allergic reaction then I'd clearly have to stop it and not re-prescribe it.” |
Newly acquired hepatitis infection | 2 (13) | “If they acquired a hepatitis infection.” |
Development of new medical contraindications | 1 (7) | “Other medical diagnoses come into play that was not there initially that, you know, we have to be aware of or would be like a relative contraindication…to continue prescribing it.” |
Pregnancy | 1 (7) | “Become pregnant…. I think that it's not approved in pregnancy.” |
Psychosis | 1 (7) | “Someone who is floridly psychotic, I wouldn't feel comfortable to prescribe [PrEP].” |
Severe side effects | 1 (7) | “If someone was having side effects or adverse effects from PrEP that were so severe that they weren't able to tolerate taking the medications and the interventions that we had recommended to decrease that [side effects].” |
Other | ||
Patient wants to stop PrEP | 1 (7) | “First of all, if the patient wants to stop, I would stop. I can't go on without their consent.” |
Availability of better biomedical prevention method | 1 (7) | “If something better comes out, like a vaginal or anal instilled product.” |