拉美裔和黑人性少数群体男性和跨性别女性中的 PrEP 停药问题：需要 PrEP 支持服务。
PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services.
机构信息
Department of Family Medicine, University of California, Los Angeles, California, United States of America.
Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California, Los Angeles, California, United States of America.
出版信息
PLoS One. 2020 Nov 5;15(11):e0241340. doi: 10.1371/journal.pone.0241340. eCollection 2020.
PURPOSE
Disparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen.
METHODS
In-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data.
RESULTS
Four themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence.
CONCLUSIONS
PrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.
目的
在与男性发生性关系的黑人和拉丁裔男同性恋者（BLMSM）以及黑人和拉丁裔跨性别女性（BLTW）中，艾滋病毒感染仍然存在差异。增加并随后持续使用暴露前预防（PrEP），这是一种预防艾滋病毒感染的有效生物医学策略，可以显著降低这些人群的艾滋病毒发病率。本研究的目的是探讨居住在洛杉矶县的 BLMSM 和 BLTW 停止使用 PrEP 的原因，以为这些人群开发支持服务提供信息，以使其坚持使用 PrEP 方案。
方法
对 15 名 BLMSM 和 7 名 BLTW 进行了深入的半结构化访谈，他们报告了暂时或无限期停止使用 PrEP。采用主题分析方法对定性数据进行分析。
结果
出现了四个与停止使用 PrEP 的原因相关的主题，包括：（1）性行为改变导致的 HIV 风险感知降低；（2）结构性或后勤障碍（例如，丧失或失去健康保险、成本、难以在复杂的医疗系统中导航）；（3）预期和经历的药物副作用，其中包括 PrEP 与女性化激素药物之间的相互作用；以及（4）药物依从性挑战。
结论
PrEP 是 BLMSM 和 BLTW 的重要预防工具，特别是在 HIV 风险增加期间。然而，个人因素（例如，无法坚持用药、HIV 性行为风险行为的改变）和结构性/后勤因素（例如，失去保险、在复杂的医疗系统中导航）都可能导致暂时或无限期停止使用 PrEP。除了医疗提供者提供的支持服务外，还需要额外的支持服务来帮助 BLMSM 和 BLTW PrEP 用户克服停药障碍，并帮助他们坚持使用 PrEP 方案。我们描述了潜在的支持服务选项，例如 PrEP 病例管理、扩大 PrEP 导航服务或短信服务。
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