Graduate School of Public Health and Health Policy, City University of New York, New York, NY.
Institute for Implementation Science in Population Health, City University of New York, New York, NY.
Transl Behav Med. 2021 Mar 16;11(2):573-581. doi: 10.1093/tbm/ibz191.
Pre-exposure prophylaxis (PrEP) is a highly effective biobehavioral strategy for preventing HIV acquisition. Although PrEP uptake has increased steadily, discontinuation rates are high among members of key populations like gay and bisexual men (GBM). Understanding the challenges that arise for PrEP users is key to better PrEP implementation and sustained use over time. We report on barriers that arose for PrEP-using GBM, as well as facilitating factors that aided PrEP persistence, with the goal of informing PrEP implementation efforts. In 2015-2016, 103 PrEP-using GBM in NYC completed qualitative interviews about their engagement with PrEP, including their experiences navigating PrEP-related medical care. Interviews were transcribed verbatim, coded, and analyzed thematically. Over half of participants (53%) received their PrEP-related care from their primary care provider (PCP), one-third (33%) from a community-based health clinic, and 13% from multiple medical providers. Emergent themes regarding the barriers and facilitators to PrEP persistence fell into two categories: insurance- and medical appointment-related barriers and facilitators to continued PrEP use. The experiences of PrEP-using GBM can provide useful insights for providers, program developers, and policymakers aiming to improve the implementation of PrEP. To support PrEP persistence, reliable insurance coverage, cost-assistance, and easy appointment scheduling are key to maintenance. Removing insurance- and appointment-related barriers to persistence may prove essential for sustaining use among GBM.
暴露前预防 (PrEP) 是预防 HIV 感染的一种高度有效的生物行为策略。尽管 PrEP 的使用率稳步上升，但在男同性恋和双性恋男性等关键人群中，PrEP 的停药率仍然很高。了解 PrEP 用户面临的挑战是改善 PrEP 实施和长期持续使用的关键。我们报告了 PrEP 使用者面临的障碍，以及有助于 PrEP 持续使用的促进因素，旨在为 PrEP 实施工作提供信息。在 2015-2016 年期间，纽约市的 103 名 PrEP 使用者完成了关于他们参与 PrEP 的定性访谈，包括他们在 PrEP 相关医疗保健方面的经历。访谈内容逐字转录、编码和主题分析。超过一半的参与者（53%）从他们的初级保健提供者（PCP）那里获得 PrEP 相关护理，三分之一（33%）从社区卫生诊所获得，13%从多个医疗提供者那里获得。关于持续使用 PrEP 的障碍和促进因素的出现主题分为两类：与保险和医疗预约相关的障碍和促进因素。PrEP 使用者的经验可以为旨在改善 PrEP 实施的提供者、项目开发者和政策制定者提供有用的见解。为了支持 PrEP 的持续使用，可靠的保险覆盖、成本援助和方便的预约安排是维持 PrEP 持续使用的关键。消除与保险和预约相关的持续使用障碍可能对维持男同性恋者的使用至关重要。
