Adherence & Discontinuation

Adherence to PrEP regimen may impact PrEP efficacy, so consistent use is required for ongoing prevention of HIV transmission through sex. However, many individuals have challenges with adherence over time and this section provides some strategies to help overcome the difficulties.1,2

Early Discontinuation of PrEP Is Common1

Discontinuation may be connected to:

  • Nonadherence
  • Intermittent usage
  • Side effects
  • Low perceived likelihood of HIV
  • Pill fatigue

Time to first PrEP discontinuation

in a study conducted in Mississippi from August 2018 – April 2021 (N=171) in individuals seeking PrEP

Chart: time to first PrEP discontinuation in study conducted from August 2018 to April 2021 (n=171) in patients seeking PrEP

Many people never refilled their initial PrEP prescriptions, with a median time to discontinuation in some regions as short as 90 days.1

HIV acquisition may increase after stopping PrEP3

In a separate study of people starting PrEP across 15 clinics in San Francisco (N=986) from July 2012 through November 2018, HIV incidence (rate per 100 person-years) was nearly 8 times higher after stopping PrEP compared with on PrEP (0.1 vs 0.8; 95% CI, 1.0-336)

Choice Can Impact Adherence and Reduce HIV Incidence4

In a global study conducted in Uganda and Kenya from January to December of 2023 in individuals aged at least 15 years with a negative HIV rapid test, during periods of self-reported likelihood of HIV, prevention coveragea in the dynamic choice HIV preventionb arm was 76.5% vs 16.2% in the SOCc arm (N=984; P<0.0001)

Offering person-centered choices generated much higher PrEP coverage and reduced HIV incidence

aProportion of follow-up time covered by either PrEP (oral PrEP or LAI) or PEP.

bA person-centered approach with a choice between oral PrEP, oral PEP, or LAI; telephone access to a clinician 24/7; HIV testing every 3 months; structured assessment of barriers to PrEP/PEP with personalized plans; reproductive health and STI support; psychological support; and the ability to switch between or stop products over time based on preference and risk.

cAccess to oral PrEP or PEP at local clinics according to country guidelines.

Strategies that make remembering, taking, and staying on PrEP easier can leverage psychology, technology, and social networks/communities5:

Psychological Strategies

  • Integrating PrEP into daily routine
  • Help individuals prepare for and address side effects

Technical Strategies

  • Physical reminders or reminder apps
  • Support patient navigation and access to medications

Social Strategies

  • Encourage check-in with friends and family
  • Peer, community, and digital support networks

PEP, post-exposure prophylaxis.

References:

  1. Chase E, Mena L, Johnson KL, Prather M, Khosropour CM. Patterns of pre-exposure prophylaxis (PrEP) use in a population accessing PrEP in Jackson, Mississippi. AIDS Behav. 2023;27(4):1082-1090. doi:10.1007/s10461-022-03845-9
  2. Centers for Disease Control and Prevention. Clinical guidance for PrEP. Updated February 10, 2025. Accessed September 29, 2025. https://www.cdc.gov/hivnexus/hcp/prep/index.html
  3. Spinelli MA, Scott H, Laborde P, et al. HIV infection after stopping PrEP in a U.S. safety-net integrated health system: a mixed methods study. Poster presented at: International AIDS Society Conference on HIV Science; July 21-24, 2019; Mexico City, Mexico
  4. Kamya MR, Balzer LB, Ayieko J, et al. Dynamic choice HIV prevention with cabotegravir long-acting injectable in rural Uganda and Kenya: a randomized trial extension. Lancet HIV. 2024;11(11):e736-e745. doi:10.1016/S2352-3018(24)00235-2
  5. Hall CDX, Bundy C, Foran CE, et al. Identifying strategies for improving pre-exposure prophylaxis adherence: perspectives from a sample of highly adherent young men who have sex with men. AIDS Behav. 2023;27(2):506-517. doi:10.1007/s10461-022-03785-4