Analysis
SECONDARY
The present analysis was restricted to the individuals’ first year of PrEP use. We conducted secondary data analysis of the parent Partners Scale‐Up Project to identify trajectories of PrEP continuation and coverage and factors associated with assignment to the different PrEP continuation trajectories. The primary outcomes were PrEP continuation and PrEP medication possession ratio (MPR) as a measure of coverage. Continuation was defined as documented visit attendance and or PrEP dispensing from pharmacy records. Refill visits completed in the period between 14 days before the expected visit date to 15 days before the next expected visit date were classified as attended. The MPR, referred to as coverage hereafter, was estimated for fixed 30‐day monthly (aligned with 30 pills per bottle), quarterly and annual periods to help account for cycling on and off PrEP. Coverage as measured by the medication possession was computed as the ratio of the total number of pills dispensed at last visit divided by the number of days in each computed period since PrEP dispensing (i.e. monthly, quarterly or annual). Coverage greater than 1 (i.e., indicating the client came back for a PrEP refill before the expected date with pills ran out) was truncated to 1, for each computed period. If a client did not have PrEP in possession, they were considered not covered during that period. For example, if a client was prescribed 30 PrEP tablets but returned for refill after 90 days (3 months), they would be considered fully covered in the first month but not covered in the second and third months and their 3‐month coverage during that period will be computed as 30 out of 90 days (or ∼33%). Dropout and non‐visit attendance were primary study outcomes and thus not treated as missing data. Although it is not possible to fully ascertain or test the true data‐generating process on the PrEP discontinuation outcome [We fit latent class mixture models (LCMMs) to identify distinct patterns of coverage in this study population [