J Gen Intern Med. 2026 Jan 27. doi: 10.1007/s11606-025-10114-7. Online ahead of print.
ABSTRACT
IMPORTANCE: Alcohol use disorder (AUD) has been associated with reduced adherence to and discontinuation of HIV preexposure prophylaxis (PrEP), potentially compromising its effectiveness.
OBJECTIVE: This study examines the relationship between AUD and PrEP adherence and continuation.
DESIGN: Retrospective cohort study using MarketScan Commercial Claims data.
PARTICIPANTS: We included individuals aged 16-64 who initiated PrEP between January 1, 2014, and December 31, 2021, and had continuous insurance coverage.
MAIN MEASURES: AUD diagnosis was identified within six months before PrEP initiation. Adherence was measured using the proportion of days covered (PDC) over 180 days and categorized by clinically relevant thresholds (≥ 85%, ≥ 80%, ≥ 57%). Continuation was assessed based on uninterrupted PrEP supply without a ≥ 30-day gap. Statistical analyses included propensity-score matching and regression modeling.
KEY RESULTS: Among 43,913 eligible individuals, 1,245 (2.84%) had an AUD diagnosis prior to PrEP initiation. In a matched sample of 1,153 individuals, those with AUD had lower mean PDC (59.54% [34.14] vs. 65.85% [33.18]; p < 0.001) and fewer mean days of continuous PrEP use (107 [67.20] days vs. 119.90 [65.21] days; p < 0.001) compared to the Without AUD group. Regression analyses showed individuals with AUD had 6.31% lower mean PDC (95% CI: -9.05% to -3.57%; p < 0.001) and 12.93 fewer days of PrEP continuity (95% CI: -18.34 to -7.52 days; p < 0.001) compared to the Without AUD group. Findings may not be generalizable beyond commercially insured individuals, and we may have not captured all factors that influence PrEP adherence.
CONCLUSION: Individuals with AUD before PrEP initiation exhibited lower adherence and continuation compared to those without AUD. Targeted interventions may be required to enhance PrEP adherence and continuity in this population.
PMID:41591743 | DOI:10.1007/s11606-025-10114-7
