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Out‐of‐pocket costs and HIV pre‐exposure prophylaxis persistence in a US multicity demonstration project
Author(s) -
Furukawa Nathan W.,
Schneider John A.,
Coleman Megan E.,
Wiener Jeffrey B.,
Shrestha Ram K.,
Smith Dawn K.
Publication year - 2020
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13285
Subject(s) - medicine , persistence (discontinuity) , proportional hazards model , hazard ratio , logistic regression , demographics , cost sharing , human immunodeficiency virus (hiv) , demography , family medicine , nursing , confidence interval , geotechnical engineering , sociology , engineering
Objective To evaluate whether out‐of‐pocket (OOP) costs reduced HIV pre‐exposure prophylaxis (PrEP) persistence. Data Source Participants from five urban community health centers (CHCs) in four US cities enrolled in a PrEP demonstration project from September 2014 to August 2017. Study Design Patients initiating PrEP were followed quarterly until they withdrew from PrEP care or the study ended. Self‐reported OOP medication and clinic visit costs were assessed by semiannual questionnaires. Persistence was defined as the time from study enrollment to the last visit after which two subsequent 3‐month visits were missed. Multivariable Cox proportional hazard regression was used to assess the effect of demographics, insurance, and OOP costs on PrEP persistence. Principal Findings Among 918 participants with OOP cost data, the average quarterly OOP cost was $34 (median: $5, IQR: $0‐$25). Participants who were men, White, employed, completed college, and had commercial insurance had higher OOP costs. Higher OOP costs were not associated with lower PrEP persistence by Cox proportional hazards regression (adjusted hazard ratio = 1.00 per $50 increase, 95% CI = 0.97, 1.02). Conclusion Among patients receiving care from these urban CHCs, OOP costs were low and did not undermine PrEP persistence.