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

Overview

Journal AIDS Behav

Specialty Infectious Diseases

Date 2022 Dec 31

PMID 36586011

Authors

Elizabeth Heilmann

Jackson Okuku

Megumi Itoh

Jonas Z Hines

Jose Tomas Prieto

Mutinta Phiri

Kelvin Watala

Chilufya Nsofu

Melinda Luhana-Phiri

Natalie Vlahakis

Michael Kabongo

Boyd Kaliki

Peter A Minchella

Bupe Musonda

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Mixed-methods protocol for the WiSSPr study: Women in Sex work, Stigma and psychosocial barriers to Pre-exposure prophylaxis in Zambia.

Kumar R, Rao D, Sharma A, Phiri J, Zimba M, Phiri M BMJ Open. 2024; 14(9):e080218.

PMID: 39242170 PMC: 11381648. DOI: 10.1136/bmjopen-2023-080218.

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