HIV 暴露前预防用药使用的实用措施分类法。
A taxonomy of pragmatic measures of HIV preexposure prophylaxis use.
机构信息
Howard Brown Health.
Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA.
出版信息
AIDS. 2020 Nov 1;34(13):1951-1957. doi: 10.1097/QAD.0000000000002618.
OBJECTIVES
As delivery of preexposure prophylaxis (PrEP) becomes an HIV prevention priority in the United States, standard, pragmatic measures of PrEP use are needed to compare and evaluate prevention implementation programs. By using readily available electronic health record data, we describe and compare measures of persistence and retention.
DESIGN
Retrospective cohort.
METHODS
Using electronic health record prescription data for patients at a large urban Federally Qualified Health Center from 2015 to 2019, we calculated measures of persistence and retention and compared them to pharmacy claims data, PrEP biomarkers, and HIV outcomes.
RESULTS
Total PrEP time was 19.8 months on average. During this period, average adherence by medication prescription ratio (MRxR) was 89%; 77% of patients had an MRxR at least 85% and 90% have an MRxR at least 57%. Over the first 6 months, average proportion of days covered (PDC) at least 85% was 53% and PDC at least 57% was 57%. Prescription fill rates, based on claims data from a pharmacy partner, ranged from 45 to 60%. Using tenofovir-diphosphate as the gold standard, PDC had high sensitivity (97%) but low specificity (≤13%). As a measure of retention, over the first 6 months, 59% of patients had quarterly HIV tests.
CONCLUSION
Total PrEP time is useful measure of overall persistence, while PDC can assess persistence and adherence at a specific time point. Adherence by PDC is more conservative compared with MRxR; both will overestimate true adherence. Retention in care can be measured by quarterly HIV tests. Using consistent terminology and reporting timepoints and adherence thresholds will help reporting and comparing PrEP delivery programs.
目的
随着在美国将暴露前预防（PrEP）的提供作为艾滋病毒预防的重点，需要使用标准的、实用的 PrEP 使用衡量标准来比较和评估预防实施计划。我们利用现成的电子健康记录数据，描述和比较了持久性和保留率的衡量标准。
设计
回顾性队列研究。
方法
使用一家大型城市联邦合格健康中心的患者的电子健康记录处方数据，我们计算了持久性和保留率的衡量标准，并将其与药房索赔数据、PrEP 生物标志物和艾滋病毒结果进行了比较。
结果
平均而言，PrEP 的总时间为 19.8 个月。在此期间，药物处方比（MRxR）的平均依从率为 89%；77%的患者 MRxR 至少为 85%，90%的患者 MRxR 至少为 57%。在前 6 个月，至少 85%的天数覆盖（PDC）的平均比例为 53%，至少 57%的 PDC 为 57%。根据一家药房合作伙伴的索赔数据，处方填充率在 45%至 60%之间。使用替诺福韦二磷酸盐作为金标准，PDC 的敏感性（97%）很高，但特异性（≤13%）较低。作为保留率的衡量标准，在前 6 个月内，59%的患者每季度进行 HIV 检测。
结论
PrEP 的总时间是总体持久性的有用衡量标准，而 PDC 可以评估特定时间点的持久性和依从性。与 MRxR 相比，PDC 下的依从性更为保守；两者都会高估真实的依从性。通过每季度进行 HIV 检测，可以衡量对治疗的保留情况。使用一致的术语和报告时间点以及依从性阈值将有助于报告和比较 PrEP 实施计划。
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