(196) Barriers to oral HIV pre-exposure prophylaxis (PrEP) perceived by those receiving an initial prescription: US survey analysis

Background: : Understanding barriers to pre-exposure prophylaxis (PrEP) initiation is critical to maximizing access. In a prior pilot study, respondents picking up an initial oral PrEP prescription reported cost and coverage issues.

Objective: : The current study uses a cross-sectional survey to assess reported pharmacy-level barriers to initial PrEP dispensation (US).

Methods: : Adults with a recent (≤7 months prior) initial PrEP prescription and no record of HIV medications in the Walgreens Pharmacy database were invited to complete a 35 question survey, deployed electronically (Mar to Dec 2024) to eligible, consenting participants. Topics included attitudes toward PrEP, out-of-pocket costs (OOPC), and prescription fill rejection reason. Responses were compared between individuals who picked up their first PrEP prescription within 14 days (prompt pickup [PP]) and individuals who did not pick up within 14 days (delayed/no pickup [D/NP]) using t-tests and Chi-square/Fisher’s exact tests (significance threshold p≤0.05). Associations between predictor variables and pickup status were evaluated with univariable (ULR) and multivariable logistic regression (MLR) analysis.

Results: : Of 39,596 invited individuals, 773 responded: 80.9% PP and 19.1% D/NP. Respondent characteristics were similar between groups, except for OOPC. Among D/NP respondents, 46.6% paid $0 for PrEP and 46.6% had no cost data, primarily due to no pickup, vs 83.5% and 1.6%, respectively, of PP respondents. In the ULR analysis, D/NP was significantly associated (odds ratios [95% CI]) with using Medicare (0.46 [0.26–0.84]) or cash/other (0.45 [0.27–0.77]) vs commercial insurance; being told there were issues with insurance processing (0.21 [0.14–0.32]); considering OOPC an important factor (0.46 [0.20–0.93]); finding difficulty in paying OOPC (0.4 [0.27–0.59]); and having recent (≤14 days prior) concerns with job stability/income (0.63 [0.40–0.99]). Numerically more D/NP than PP reported difficulties with housing, transportation, and acquiring basic necessities. PP was significantly associated with being able to meet recent monthly expenses (1.82 [1.23–2.69]) and not having higher than expected recent OOPC (1.86 [1.17–2.96]). No strong associations were found between pickup group and PrEP attitudes, stigma, and self-efficacy.

Conclusions: : Cost concerns and insurance coverage issues were significantly more prevalent among individuals with D/NP vs PP of their first PrEP prescription. Efforts to further encourage PrEP initiation by improving access should target expanding formulary coverage and streamlining pharmacy claims adjudication.

Sponsorship:: Gilead Sciences, Inc.