Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, USA.
AIDS Patient Care STDS. 2020 Jun;34(6):251-258. doi: 10.1089/apc.2019.0288.
Despite being a promising prevention strategy for populations at risk for HIV acquisition, there has not been rapid uptake of HIV antiretroviral pre-exposure prophylaxis (PrEP). Yet, HIV clinics within the Mount Sinai Health System in New York City have successfully incorporated PrEP. HIV care providers ( = 18), who practice in these clinics and were early PrEP adopters, participated in a survey and semistructured interview. Qualitative thematic analysis revealed that barriers and facilitators to PrEP uptake were identified on multiple levels from broader systemic to provider-and-patient-level concerns. The following themes were identified: (1) to reach a greater proportion of patients at risk for HIV and address racial/ethnic and gender disparities, PrEP should be available in a variety of settings and provided by different types of providers within proximity to affected populations; (2) financial support is needed beyond addressing medication cost; and (3) multidisciplinary teams and population-specific clinic protocols can assist providers in conducting high-quality visits and addressing these barriers to PrEP.
尽管针对有感染 HIV 风险的人群,艾滋病毒抗逆转录病毒预防用药(PrEP)是一种很有前途的预防策略,但并未得到迅速推广。然而,纽约市西奈山卫生系统的 HIV 诊所已经成功地采用了 PrEP。在这些诊所工作并较早采用 PrEP 的 HIV 护理提供者( = 18)参与了一项调查和半结构化访谈。定性主题分析显示,从更广泛的系统层面到提供者和患者层面的问题,PrEP 的采用存在多种障碍和促进因素。确定了以下主题:(1)为了让更多处于 HIV 感染风险中的患者获得 PrEP,并解决种族/族裔和性别差异,PrEP 应该在各种环境中提供,由接近受影响人群的不同类型的提供者提供;(2)除了解决药物费用外,还需要财政支持;(3)多学科团队和针对特定人群的诊所方案可以帮助提供者进行高质量的就诊,并解决 PrEP 的这些障碍。