Parsons Jeffrey T, Rendina H Jonathon, Lassiter Jonathan M, Whitfield Thomas H F, Starks Tyrel J, Grov Christian
*Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY; †Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY; ‡Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY; and §CUNY Graduate School of Public Health and Health Policy, New York, NY.
J Acquir Immune Defic Syndr. 2017 Mar 1;74(3):285-292. doi: 10.1097/QAI.0000000000001251.
The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational pre-exposure prophylaxis (PrEP) Cascade involving 5 stages based on the Transtheoretical Model of Change.
We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States.
Nearly all (89%) participants were sexually active in the past 3 months and 65% met Centers for Disease Control criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (stage 5).
The large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.
艾滋病病毒护理级联提供了一些里程碑，用于追踪艾滋病病毒阳性者从血清转化到病毒抑制的进展情况。我们基于行为改变阶段理论提出了一个包含5个阶段的动机性暴露前预防（PrEP）级联。
我们分析了来自“千名壮汉”研究中995名男性的数据，该研究是对美国一组全国性的艾滋病病毒阴性男同性恋者和双性恋者进行的纵向研究。
几乎所有（89%）参与者在过去3个月内有性行为，65%符合疾病控制中心的PrEP候选标准。在那些被确定为合适候选者的人中，53%处于未考虑阶段（第1阶段；不愿意服用或认为自己不适合PrEP），23%处于考虑阶段（第2阶段；愿意且自认为是合适候选者）。只有11%处于准备阶段（第3阶段；认为PrEP可获取并计划开始使用PrEP），4%处于PrEP行动阶段（第4阶段；已开具PrEP处方）。虽然被确定为合适候选者的人中很少有人正在使用PrEP，但几乎所有PrEP使用者（98%）报告每周坚持服用4剂或更多剂，且大多数（72%）会按建议每季度复诊，这使得9%的PrEP候选者达到维持和依从阶段（第5阶段）。
绝大多数参与者是PrEP的合适候选者，但每10人中使用并坚持PrEP的不到1人。这些发现凸显了需要采取针对性干预措施，以解决男性在级联各阶段面临的独特障碍，尤其是在发现损失最大的最早阶段。
