Measuring Oral Pre-exposure Prophylaxis (PrEP) Continuation Through Electronic Health Records During Program Scale-Up Among the General Population in Zambia

Details

• Alternative Title:
  AIDS Behav
• Personal Author:
  Heilmann, Elizabeth ; Okuku, Jackson ; Itoh, Megumi ; Hines, Jonas Z. ; Prieto, Jose Tomas ; Phiri, Mutinta ; Watala, Kelvin ; Nsofu, Chilufya ; Luhana-Phiri, Melinda ; Vlahakis, Natalie ; Kabongo, Michael ; Kaliki, Boyd ; Minchella, Peter A. ; Musonda, Bupe
• Description:
  HIV pre-exposure prophylaxis (PrEP) is being scaled-up in Zambia, but PrEP continuation data are limited by paper-based registers and aggregate reports. Utilization of Zambia's electronic health record (EHR) system, SmartCare, may address this gap. We analyzed individuals aged ≥ 15 years who initiated PrEP between October 2020 and September 2021 in four provinces in Zambia in SmartCare versus aggregate reports. We measured PrEP continuation using Kaplan-Meier survival analysis and Cox proportional hazards models. SmartCare captured 29% (16,791/58,010) of new PrEP clients; 49% of clients continued at one month, and 89% discontinued PrEP by February 2022. Women were less likely than men to discontinue PrEP (adjusted hazard ratio [aHR]: 0.89, 95% CI 0.86-0.92, z = - 6.99, p < 0.001), and PrEP clients aged ≥ 50 years were less likely to discontinue PrEP compared to clients 15-19 years (aHR: 0.53, 95% CI 0.48-0.58, z = - 13.04, p < 0.001). Zambia's EHR is a valuable resource for measuring individual-level PrEP continuation over time and can be used to inform HIV prevention programs.
• Subjects:
  Anti-HIV Agents Electronic Health Records Female HIV Infections Humans Male Pre-Exposure Prophylaxis Zambia
• Keywords:
  Africa HIV Prevention Oral Pre-exposure Prophylaxis PrEP
• Source:
  AIDS Behav. 27(7):2390-2396
• Pubmed ID:
  36586011
• Pubmed Central ID:
  PMC11345677
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; NU2GGH002093/CC/CDC HHSUnited States/ ; 5 NU2GGH002093-05-00/CC/CDC HHSUnited States/
• Volume:
  27
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:5ebe7dcf76b74dfd542e36339a720faa9fdf6f88408e09a44d4cb0dd077caae9ab62a3e17c96a601634c385445fb193f034056f8e56639886c2962454775109d
• Download URL:
  https://stacks.cdc.gov/view/cdc/160641/cdc_160641_DS1.pdf
• File Type:
  [PDF - 583.88 KB ]