Background: While oral PrEP represents a significant biomedical addition to HIV prevention, efficacy depends on persistent use. Daily use is recommended by WHO for those at substantial risk. Given the vast typology of risky sexual behaviors, no single PrEP dosing regimen suits all, and many clients may be expected to take PrEP episodically for intermittent risk. The objective of this abstract is to characterize Jilinde clients with non-continuous PrEP refills as a proxy for episodic use in Kenya.
Methods: Prescription and de-identified client data routinely collected by the standardized national PrEP medical record form were included in our analysis from those starting PrEP between February 2017 - June 2018. We evaluated the characteristics of clients with single and multiple uses, the latter defined as those with an elapsed duration of > 45 days between prescriptions, indicative of non-daily use. A generalized linear model was used to compute the beta coefficient with number of use episodes.
Results: Jilinde initiated 16,291 PrEP clients: 74% female; 53% aged > 25 years; 69% single/never married; and, 60% female sex workers (FSW). Seventy-two percent (11,734) had only a single use (of varying duration); whereas, 3,062 (19%), 982 (6%) and 505 (3%) had 2, 3 and > 4 use episodes. The maximum number of use episodes observed was 8. Users with multiple uses had a mean elapsed duration of 76 days (standard deviation (SD)=195) between the first and refill prescriptions. The mean duration of use for the first use episode was 67 days (SD=40). Independent predictors of increasing number of use episodes included being older, referral channel within facility, being a FSW and having an HIV positive partner.
Conclusions: Approximately 25% of those starting PrEP had some interruption in daily use followed by at least one restart at a later date. Though we found statistically significant predictors of repeated use, effect sizes were minimal, suggesting the phenomenon of multiple use episodes is not unique to any particular sub-group. Therefore, all clients should be counseled about the importance of daily use throughout periods of risk, and effective non-daily dosing regimens and complementary counseling should be explored for those with intermittent risk.

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