Doblecki-Lewis Susanne, Butts Stefani, Botero Valeria, Klose Katherine, Cardenas Gabriel, Feaster Daniel
1 Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
2 Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
J Int Assoc Provid AIDS Care. 2019 Jan-Dec;18:2325958219848848. doi: 10.1177/2325958219848848.
Effective approaches to promoting pre-exposure prophylaxis (PrEP) and linkage to PrEP care among those who may benefit the most from PrEP has proven to be a major challenge. We designed and pilot tested a strengths-based case management (SBCM) intervention for PrEP linkage. Adults interested in PrEP and meeting criteria (n = 61) were randomized to passive referral (control) or active SBCM (treatment). Outcomes measured were completion of provider visit, initiation of PrEP, and time to initiation of PrEP. Overall, 34% initiated PrEP by 12 weeks: 9 (29%) in the control group and 12 (40%) in the treatment group. The mean time to PrEP initiation was 13.1 weeks (95% confidence interval, 12.0-14.2) with no difference between groups ( P = .382). There was a 21% difference in achieving a provider visit between the treatment and control groups (53.3% versus 32.3%) by 12 weeks ( P = .096). Participants encountered financial, logistical, social, and provider-related barriers to PrEP access. Strengths-based case management-based patient navigation is a promising strategy for assisting PrEP seekers in obtaining a medical provider visit and initiating PrEP.
事实证明，对于那些最能从暴露前预防（PrEP）中获益的人群，推广PrEP并使其与PrEP护理建立联系的有效方法是一项重大挑战。我们设计并进行了一项基于优势的病例管理（SBCM）干预措施以促进PrEP联系。符合标准且对PrEP感兴趣的成年人（n = 61）被随机分为被动转诊组（对照组）或积极SBCM组（治疗组）。测量的结果包括完成医疗服务提供者就诊、开始PrEP以及开始PrEP的时间。总体而言，到12周时，34%的人开始使用PrEP：对照组中有9人（29%），治疗组中有12人（40%）。开始PrEP的平均时间为13.1周（95%置信区间，12.0 - 14.2），两组之间无差异（P = 0.382）。到12周时，治疗组和对照组在完成医疗服务提供者就诊方面存在21%的差异（53.3%对32.3%）（P = 0.096）。参与者在获取PrEP时遇到了经济、后勤、社会和与医疗服务提供者相关的障碍。基于优势的病例管理的患者导航是一种有前景的策略，可帮助PrEP寻求者获得医疗服务提供者就诊并开始使用PrEP。
