Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
Clin Infect Dis. 2019 Jan 1;68(1):37-42. doi: 10.1093/cid/ciy441.
Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important human immunodeficiency virus (HIV) prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits that occur prior to HIV infection.
This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, healthcare visits and providers, sexually transmitted diseases (STDs), and other diagnoses were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision.
Of 885 persons newly diagnosed during the study period, 586 (66%) had 4029 visits to a healthcare facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine-trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted 10% of visits. Also, 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance. In multivariable analyses, being female, black, or aged <30 years were statistically significant predictors of having prior healthcare visits. Among persons with at least 1 healthcare visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit.
Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition.
扩大暴露前预防（PrEP）的使用，以解决当前的种族/民族差异，是预防人类免疫缺陷病毒（HIV）的一个重要目标。我们研究了在 HIV 感染之前的医疗保健就诊中，提供 PrEP 的机会缺失情况。
本回顾性队列研究将南卡罗来纳州 HIV 病例监测数据与 3 个全州医疗保健数据库相联系。在首次 HIV 诊断之前，评估了患者、医疗保健就诊和提供者、性传播疾病（STD）以及其他诊断的特征。使用调整后的优势比来确定提供 PrEP 机会缺失的相关因素。
在研究期间，新诊断的 885 人中，有 586 人（66%）在 HIV 诊断前有 4029 次医疗保健就诊（平均就诊 6.9 次），存在提供 PrEP 的机会缺失。接受过急诊医学培训的临床医生（61%）和初级保健临床医生（家庭医学或内科）进行了 10%的就诊。此外，42%的就诊者没有医疗保险或自付费用，36%的人有公共保险，18%的人有商业保险。在多变量分析中，女性、黑人或年龄<30 岁是有先前医疗保健就诊史的统计学显著预测因素。在至少有 1 次 HIV 诊断前医疗保健就诊的人中，28.5%的人在任何就诊时都被诊断患有淋病、梅毒或衣原体感染。
应利用在 PrEP 获益人群中发生的医疗保健就诊机会，尤其是患有已确诊 STD 的人群，增加 PrEP 的使用，并降低 HIV 感染的风险。
