From the Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts; Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
Am J Prev Med. 2021 Mar;60(3):369-378. doi: 10.1016/j.amepre.2020.09.011. Epub 2020 Nov 21.
In Massachusetts, recent outbreaks of HIV have been fueled by injection and sexual exposures among people who inject drugs. Understanding pre-exposure prophylaxis need, knowledge, and use among people who inject drugs will help inform and evaluate interventions.
In 2019, investigators analyzed 2018 National HIV Behavioral Surveillance data from people who inject drugs in Boston, MA, who met eligibility criteria. Proportions of people who inject drugs with U.S. Preventive Services Task Force-based pre-exposure prophylaxis indication were estimated by types of HIV acquisition risk in the past year: injection exposure only, sexual exposure only, and overlapping injection and sexual exposures. Investigators then evaluated pre-exposure prophylaxis awareness, conversations with healthcare providers about pre-exposure prophylaxis, and self-reported pre-exposure prophylaxis use among those with and without pre-exposure prophylaxis indications.
The prevalence of pre-exposure prophylaxis indication was 92% overall (389/423), with 290 (69%) participants indicated for injection exposures only, 3 (<1%) indicated for sexual exposures only, and 96 (23%) indicated for both injection and sexual exposures. Among those indicated for pre-exposure prophylaxis (n=389), 152 (39%) reported being aware of pre-exposure prophylaxis, 41 (11%) had discussed pre-exposure prophylaxis with a healthcare provider, and 8 (2%) had used pre-exposure prophylaxis in the past year. There were no statistically significant differences between pre-exposure prophylaxis‒indicated and ‒nonindicated people who inject drugs with respect to pre-exposure prophylaxis awareness, discussion with a healthcare provider, and pre-exposure prophylaxis use.
Indication for pre-exposure prophylaxis was high, but awareness was low, conversations about pre-exposure prophylaxis with healthcare providers were uncommon, and pre-exposure prophylaxis use was extremely low. These findings highlight important areas for clinical and community-based interventions to improve pre-exposure prophylaxis uptake among and delivery to people who inject drugs.
在马萨诸塞州，最近的艾滋病毒疫情是由注射毒品者的注射和性接触引发的。了解注射毒品者对暴露前预防的需求、知识和使用情况，将有助于为干预措施提供信息并进行评估。
2019 年，研究人员分析了 2018 年在马萨诸塞州波士顿符合条件的注射毒品者的国家艾滋病毒行为监测数据。根据过去一年中不同类型的艾滋病毒感染风险，估计有美国预防服务工作组（U.S. Preventive Services Task Force）推荐的暴露前预防指征的注射毒品者的比例：仅注射暴露、仅性暴露和重叠的注射和性暴露。然后，研究人员评估了那些有和没有暴露前预防指征的人对暴露前预防的认识、与医疗保健提供者讨论暴露前预防的情况以及自我报告的暴露前预防使用情况。
总体而言，暴露前预防指征的流行率为 92%（389/423），其中 290 人（69%）仅因注射暴露而被指示，3 人（<1%）仅因性暴露而被指示，96 人（23%）因注射和性暴露而被指示。在有暴露前预防指征的人中（n=389），152 人（39%）表示知道暴露前预防，41 人（11%）与医疗保健提供者讨论过暴露前预防，8 人（2%）在过去一年中使用过暴露前预防。在暴露前预防指征和非指征的注射毒品者中，在暴露前预防意识、与医疗保健提供者的讨论以及暴露前预防的使用方面，没有统计学上的显著差异。
暴露前预防指征很高，但意识很低，与医疗保健提供者讨论暴露前预防的情况并不常见，暴露前预防的使用也极低。这些发现突出了临床和社区干预措施的重要领域，以提高注射毒品者对暴露前预防的接受度和获得情况。
