Chan Philip A, Mena Leandro, Patel Rupa, Oldenburg Catherine E, Beauchamps Laura, Perez-Brumer Amaya G, Parker Sharon, Mayer Kenneth H, Mimiaga Matthew J, Nunn Amy
Division of Infectious Diseases, The Miriam Hospital, Brown University, Providence, RI, USA;
Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA.
J Int AIDS Soc. 2016 Jun 13;19(1):20903. doi: 10.7448/IAS.19.1.20903. eCollection 2016.
Despite the efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV transmission, few studies have evaluated PrEP use and retention in care outcomes in real-world settings outside of clinical trials.
Data were collected from PrEP clinical care programmes in three mid-size US cities: Providence, Rhode Island (RI); Jackson, Mississippi (MS); and St. Louis, Missouri (MO). We assessed the demographic and social characteristics of patients prescribed PrEP and documented their insurance and copayment experiences. We assessed retention in PrEP care at three and six months. Multivariate analyses were used to predict retention in care among men who have sex with men (MSM). HIV acquisition among the cohort was also assessed.
A total of 267 (RI: 117; MS: 88; MO: 62) patients were prescribed PrEP; 81% filled prescriptions (RI: 73%; MS: 82%; MO: 94%; p<0.001). Patients in MS and MO were more commonly African American than in RI (72% and 26% vs. 7%, respectively), but less frequently Latino (2% and 3% vs. 24%, respectively). More patients reported living below the federal poverty line in MS (52%) compared to MO (23%) and RI (26%). Most patients were MSM (RI: 92%; MS: 88%; MO: 84%). The majority of MSM reported recent condomless anal sex (RI: 70%; MS: 65%; MO: 75%). Among 171 patients prescribed PrEP at least six months beforehand, 72% were retained in care at three months (RI: 68%; MS: 70%; MO: 87%; p=0.12) and 57% were retained in PrEP care at six months (RI: 53%: MS: 61%; MO: 63%; p=0.51). Insurance status and medication costs were not found to be significant barriers for obtaining PrEP. Three patients became infected with HIV during the six-month period after being prescribed PrEP (1.1%; 3/267), including one in RI (suspected acute HIV infection), one in MO (confirmed poor adherence) and one in MS (seroconverted just prior to initiation).
PrEP initiation and retention in care differed across these distinct settings. In contrast, retention in PrEP care was consistently suboptimal across sites. Further research is needed to identify the individual, social and structural factors that may impede or enhance retention in PrEP care.
尽管暴露前预防（PrEP）在预防艾滋病毒传播方面具有疗效，但很少有研究评估在临床试验之外的现实环境中PrEP的使用情况及持续治疗效果。
数据收集自美国三个中等规模城市的PrEP临床护理项目：罗德岛州普罗维登斯市；密西西比州杰克逊市；密苏里州圣路易斯市。我们评估了开具PrEP处方患者的人口统计学和社会特征，并记录了他们的保险及自付费用情况。我们评估了三个月和六个月时PrEP护理的持续情况。采用多变量分析来预测男男性行为者（MSM）的持续治疗情况。还评估了该队列中的艾滋病毒感染情况。
共有267名患者（普罗维登斯市：117名；杰克逊市：88名；圣路易斯市：62名）开具了PrEP处方；81%的患者取药（普罗维登斯市：73%；杰克逊市：82%；圣路易斯市：94%；p<0.001）。与普罗维登斯市相比，杰克逊市和圣路易斯市的非裔美国患者更为常见（分别为72%和26%，而普罗维登斯市为7%），但拉丁裔患者较少（分别为2%和3%，而普罗维登斯市为24%）。与圣路易斯市（23%）和普罗维登斯市（26%）相比，杰克逊市更多患者报告生活在联邦贫困线以下（52%）。大多数患者为男男性行为者（普罗维登斯市：92%；杰克逊市：88%；圣路易斯市：84%）。大多数男男性行为者报告最近有无保护肛交行为（普罗维登斯市：70%；杰克逊市：65%；圣路易斯市：75%）。在至少提前六个月开具PrEP处方的171名患者中，72%在三个月时仍接受护理（普罗维登斯市：68%；杰克逊市：70%；圣路易斯市：87%；p=0.12），57%在六个月时仍接受PrEP护理（普罗维登斯市：53%；杰克逊市：61%；圣路易斯市：63%；p=0.51）。未发现保险状况和药物费用是获取PrEP的重大障碍。三名患者在开具PrEP处方后的六个月内感染了艾滋病毒（1.1%；267例中有3例），包括普罗维登斯市的1例（疑似急性艾滋病毒感染）、圣路易斯市的1例（确认依从性差）和杰克逊市的1例（开始治疗前血清转化）。
在这些不同的环境中，PrEP的起始和持续护理情况有所不同。相比之下，各地点PrEP护理的持续情况一直不理想。需要进一步研究以确定可能阻碍或促进PrEP护理持续情况的个体、社会和结构因素。
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