Despite its efficacy and safety, HIV pre-exposure prophylaxis (PrEP) still faces high rates of discontinuation and lack of awareness, undermining its role in HIV prevention among populations at higher risk of exposure. This study aimed to analyze sociodemographic and clinical factors associated with PrEP adherence and discontinuation. The study was conducted in a Specialized Care Service in central Rio Grande do Sul (IRB approval no. 5.641.756), including PrEP users between November 2020 and August 2023 who had at least one dispensing. Statistical analysis showed significant associations between adherence/discontinuation and variables such as age, sex assigned at birth, sexual orientation, schooling, skin color, priority population profile, and serological markers (anti-HBs and HAV-IgG). Younger individuals (18–24 years) had higher discontinuation (60.4%), whereas those ≥ 40 years showed higher adherence (62.2%) (p = 0.003). Men had higher adherence (52.1%) than women (26.7%) (p = 0.008). Homosexual individuals had better adherence (54.8%) compared with heterosexuals (37.2%) (p = 0.006). Low schooling (< 8 years) was associated with higher discontinuation (70.4%) (p = 0.029), and White individuals had higher adherence (53.5%) than Brown (46.9%) and Black (33.3%) individuals (p = 0.010). In multivariable logistic regression, male sex was strongly associated with adherence to PrEP (aOR=14.52; 95% CI: 1.51–1.94; p = 0.001), as was age 18–24 years (aOR = 12.01; 95% CI: 2.36–5.36; p = 0.001). Low schooling predicted discontinuation (aOR = 7.65; 95% CI: 2.36–5.36; p = 0.006). White individuals had lower risk of discontinuation (aOR = 0.10; 95% CI: 0.12–0.39; p = 0.001), and homosexual individuals showed greater adherence compared with heterosexual and bisexual individuals (aOR = 0.38; 95% CI: 0.10–0.13; p = 0.003). Individuals seronegative for anti-HBs and HAV-IgG had increased risk of discontinuation (p = 0.001 for both). The findings underscore the importance of targeted strategies to reduce inequalities in PrEP access and continuity, especially among youth, people with low schooling, cisgender women, non-White populations, and individuals outside priority groups, thereby contributing to reduced HIV infection rates.
Poitevin et al. (Sun,) studied this question.