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<p>Event-driven dosing is the preferred option for oral pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Taiwan. A key challenge to PrEP scale-up is discontinuation at clinical follow-up, with event-driven users potentially facing higher risk of discontinuation and missing routine health checks. This study examined PrEP discontinuation and associated factors in a sample with a high proportion of event-driven users. Adult MSM receiving PrEP at a medical center in southern Taiwan were enrolled in 2018–2023. PrEP discontinuation, defined as no clinical visit for over 6&#xa0;months, was analysed using Kaplan–Meier and log-rank tests comparing dosing regimen groups. Cox regression models with time-varying covariates were performed to identify associations between PrEP user characteristics and discontinuation. A total of 301 MSM with a median age of 28&#xa0;years were analysed. Over 1379 person-times of follow-up, 57.1% discontinued PrEP within one year, with median time of 210&#xa0;days. Cox regression models incorporating time-varying covariates for PrEP regimen and behavioral factors indicated that event-driven PrEP use (aHR = 1.87, 95% CI 1.01–3.49), higher monthly salary (aHR = 1.87, 95% CI 1.18–2.95), and lack of government-subsidized PrEP (aHR = 2.14, 95% CI 1.38–3.32) were associated with higher risk of PrEP discontinuation at clinical follow-up. Event-driven users show higher discontinuation rates at clinical follow-up in Taiwan. Differentiated service delivery better-tailoring resources to PrEP users’ demand should be developed such as flexible visit schedules, telemedicine consultations, and community-based PrEP refill programs as many MSM prefer event-driven regimens.</p>

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Discontinuation of Pre-exposure Prophylaxis in Men Who Have Sex with Men in Taiwan: A Prospective Study of Event-Driven Regimens

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Yi-Jhen Chen,
  • Chia-Wen Li,
  • Huei-Jiuan Wu,
  • Stephane Wen-Wei Ku,
  • Pei-Chen Lee,
  • Carol Strong

摘要

Event-driven dosing is the preferred option for oral pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Taiwan. A key challenge to PrEP scale-up is discontinuation at clinical follow-up, with event-driven users potentially facing higher risk of discontinuation and missing routine health checks. This study examined PrEP discontinuation and associated factors in a sample with a high proportion of event-driven users. Adult MSM receiving PrEP at a medical center in southern Taiwan were enrolled in 2018–2023. PrEP discontinuation, defined as no clinical visit for over 6 months, was analysed using Kaplan–Meier and log-rank tests comparing dosing regimen groups. Cox regression models with time-varying covariates were performed to identify associations between PrEP user characteristics and discontinuation. A total of 301 MSM with a median age of 28 years were analysed. Over 1379 person-times of follow-up, 57.1% discontinued PrEP within one year, with median time of 210 days. Cox regression models incorporating time-varying covariates for PrEP regimen and behavioral factors indicated that event-driven PrEP use (aHR = 1.87, 95% CI 1.01–3.49), higher monthly salary (aHR = 1.87, 95% CI 1.18–2.95), and lack of government-subsidized PrEP (aHR = 2.14, 95% CI 1.38–3.32) were associated with higher risk of PrEP discontinuation at clinical follow-up. Event-driven users show higher discontinuation rates at clinical follow-up in Taiwan. Differentiated service delivery better-tailoring resources to PrEP users’ demand should be developed such as flexible visit schedules, telemedicine consultations, and community-based PrEP refill programs as many MSM prefer event-driven regimens.