Journal of Acquired Immune Deficiency Syndromes   |  August 5, 2017

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We applaud the analyses elucidating the differences in HIV pre-exposure prophylaxis (PrEP) access in states with different public insurance programs (Doblecki-Lewis et al’s1 “Healthcare Access and PrEP Continuation in San Francisco and Miami”). Their open-label demonstration study evaluated 173 patients in San Francisco and Miami after completion of a National Institutes of Health–sponsored PrEP demonstration project.2 PrEP was originally provided free of charge at these sites during a 3-year study. However, although 92% (159/173) reported interest in continuing PrEP after the study’s conclusion, only 40% (69/171) of participants reported continuing PrEP 4–6 months after the study ended. Moreover, among individuals who did continue PrEP, 33% (23/69) reported a gap in taking medication; the average gap was close to 2 months. These important findings highlight the challenges associated with transitioning participants in research studies and demonstration projects to real-world clinical care programs; these challenges are particularly acute for men who have sex with men (MSM) of color who bear a disproportionate share of the HIV disease burden in the United States.

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