Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States.
Department of Epidemiology and Biostatistics, School of Public Health, SUNY, University of Albany, Rensselaer, NY, United States.
J Int AIDS Soc. 2019 Oct;22(10):e25399. doi: 10.1002/jia2.25399.
Delays between receiving a PrEP prescription and taking a first dose increase the risk of HIV infection. This is especially relevant in populations with high HIV incidence, such as young black men who have sex with men (YBMSM) in the United States. Additionally, YBMSM have relatively low levels of health insurance. We investigated whether lack of health insurance and reliance on PrEP funding through the manufacturer assistance programme (MAP) leads to delays in initiation of PrEP.
HIV-negative YBMSM were offered PrEP as part of a prospective cohort. Enrolment began in June 2015 with follow-up through February 2019. Interested participants attended a PrEP clinician visit and received a prescription. Those with health insurance received a copay assistance card; those without insurance accessed PrEP using the MAP. The primary outcome was the days between prescription and initiation. The effect of insurance status on this delay was modelled using a Cox proportional hazards model.
The median delay between receipt of a PrEP prescription and taking a first dose was 12 days (IQR 3 to 32). Compared to uninsured participants, the adjusted hazard ratio for PrEP initiation for those with insurance was 2.72 (95% CI 1.82 to 4.06). The adjusted median time to initiation for insured participants was 5 days versus 21 days for those without insurance (p < 0.0001). Older age and STI diagnosis were also associated with faster PrEP initiation. Despite equivalent access to PrEP provided by the study, YBMSM without insurance had longer delays in initiation after receipt of a prescription. Overall, the observed delay in PrEP initiation increases the chances of HIV infection and the possibility of PrEP initiation after undetected seroconversion.
The extended time period between PrEP prescription and taking a first dose increases the risk of HIV transmission. Younger YBMSM and those without health insurance had longer delays in PrEP initiation. Immediate PrEP initiation programmes could decrease the likelihood of this occurrence and mitigate the disparity in initiation between those with and without health insurance. Clinical Trial Number: NCT02503618.
接受 PrEP 处方与开始服用第一剂之间的延迟会增加感染 HIV 的风险。这在美国的年轻黑人男男性行为者（YBMSM）等 HIV 发病率较高的人群中尤为重要。此外，YBMSM 的健康保险水平相对较低。我们调查了缺乏健康保险以及依赖制造商援助计划（MAP）获得 PrEP 资金是否会导致 PrEP 开始延迟。
HIV 阴性的 YBMSM 作为前瞻性队列的一部分被提供 PrEP。招募工作于 2015 年 6 月开始，随访至 2019 年 2 月。有兴趣的参与者参加 PrEP 临床医生就诊并获得处方。有保险的人会收到一张共付卡；没有保险的人则通过 MAP 获得 PrEP。主要结果是从处方到开始的天数。使用 Cox 比例风险模型对保险状况对这种延迟的影响进行建模。
收到 PrEP 处方和开始服用第一剂之间的中位数延迟为 12 天（IQR 3 至 32）。与没有保险的参与者相比，有保险的参与者开始使用 PrEP 的调整后的风险比为 2.72（95%CI 1.82 至 4.06）。有保险的参与者开始接受治疗的调整后中位时间为 5 天，而没有保险的参与者为 21 天（p<0.0001）。年龄较大和性传播感染的诊断也与更快地开始 PrEP 相关。尽管研究提供了同等的 PrEP 获得途径，但在收到处方后，没有保险的 YBMSM 开始 PrEP 的延迟时间更长。总体而言，PrEP 开始延迟增加了 HIV 感染的机会，并增加了 PrEP 开始后未检测到血清转换的可能性。
PrEP 处方和开始服用第一剂之间的延长时间会增加 HIV 传播的风险。年轻的 YBMSM 和没有健康保险的人开始接受 PrEP 的延迟时间更长。立即开始 PrEP 方案可以降低这种情况发生的可能性，并减轻有和没有健康保险的人之间开始 PrEP 的差异。临床试验编号：NCT02503618。
