PrEP Adherence Linked to Area Deprivation Index in Ohio

Pre-exposure prophylaxis (PrEP) is the primary means of avoiding HIV infection,1 making adherence paramount to ending the HIV epidemic. A new study, published in the Journal of General Internal Medicine,2 found that adherence to the medication could rely on area deprivation index (ADI), specifically in Ohio.

Adherence to PrEP has been suboptimal in the US, leading to the continuation of the HIV epidemic in the country. ADI can be a tool for measuring social determinants of health that can help to assess the reasons for non-adherence to PrEP. This study aimed to evaluate primary and secondary adherence to PrEP using ADI and race of patients.

Adherence to PrEP was linked to ADI in Ohio | Image credit: alimyakubov - stock.adobe.com

Patients who were naïve to PrEP, aged 18 years or older, and were prescribed PrEP between 2018 and 2024 at the Cleveland Clinic Health System were included in this study. Quintiles standardized for Ohio were used to separate ADI measurements, with the fifth quintile representing the highest disadvantage and the first quintile representing the lowest disadvantage. Any prescription of tenofovir/emtricitabine (Truvada; Gilead Sciences, Inc), emtricitabine/tenofovir alafenamide (Descovy; Gilead Sciences, Inc), and cabotegravir (Apretude; ViiV Healthcare), or their generic versions, was considered as a PrEP prescription in the study.

Adherence was measured through pharmacy fill data. Primary adherence was a fill within 60 days, secondary adherence was measured as a proportion of day’s covered that was greater than 80% after 6 months. Mixed-effects logistic regression was used to assess the odds of primary and secondary adherence based on ADI quintile. An analysis was also done to assess the differences in adherence between White and Black patients in the first and fifth quintiles.

There were 1459 patients included in this study, of which 54% met criteria for primary adherence. Secondary adherence was found in 46% of those who met criteria for primary adherence. White patients were more likely to meet criteria for primary adherence compared with Black patients (53% vs 43%).

A total of 49% of those in the first quintile met criteria for primary adherence compared with 56% of those in the fifth quintile. A total of 46% of White patients in the first quintile had primary adherence compared with 52% of Black patients; the fifth quintile had 64% of White patients who met primary adherence compared with 38% of Black patients.

Greater odds of primary adherence were found in those at highest disadvantage compared with lowest (OR, 1.53; 95% CI, 1.07-2.21). Black race was associated with lower odds of primary adherence compared with White race (OR, 0.59; 95% CI, 0.43-0.83). Secondary adherence was not associated with ADI or race.

There were some limitations to this study. Confounding could have potentially gone unmeasured. Specialty pharmacies for PrEP fills may not have been accounted for in this study, underestimating adherence in some patients.

Overall, the researchers found that “patients residing in geographic areas with the highest disadvantage had better primary adherence than those living in areas with the lowest disadvantage,” which could highlight the challenges of using ADI to understand patient adherence to PrEP. The researchers also concluded that more outreach to Black patients was needed given the disparities in adherence found between them and White patients.

References

1. Pre-exposure prophylaxis. HIV.gov. Updated July 9, 2025. Accessed August 5, 2025. https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis

2. Shu J, Momtazi-Mar L, Kovach JD, Ng H, Martinez KA. Variation in HIV pre-exposure prophylaxis (PrEP) adherence by Area Deprivation Index. J Gen Intern Med. Published online August 4, 2025. doi:10.1007/s11606-025-09790-2