Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Center for Child and Community Health Research, John Hopkins University School of Medicine, Baltimore, MD.
J Acquir Immune Defic Syndr. 2021 Jul 1;87(3):918-927. doi: 10.1097/QAI.0000000000002668.
Successful linkage to preexposure prophylaxis (PrEP) and retention in care are important for HIV prevention. We examined gaps in PrEP care following referral and factors associated with PrEP linkage and persistence in an integrated health care system in the United States.
We identified individuals referred for PrEP from 2014 to 2017 at the Kaiser Permanente Southern California using electronic health records and assessed linkage to care, PrEP prescription orders and fills, and PrEP persistence (medication possession ratio ≥80%) in the year after the first fill. We evaluated demographic and clinical factors potentially associated with PrEP linkage and persistence using a series of multivariable modified Poisson regression models.
Of 2995 referred individuals, 74.9% were linked to PrEP care. Nearly all those linked to care were prescribed PrEP and filled a prescription, but only 47.4% of those who filled a prescription were persistent on PrEP. Individuals aged <25 years (vs ≥25 years), female subjects (vs males), and individuals with high-deductible insurance (vs no high deductible) were less likely to be linked to care. Individuals aged <25 years and Hispanics (vs non-Hispanic whites) were less likely to be persistent. Those with alcohol use disorder were more likely to be linked to PrEP care but less likely to be persistent. New HIV diagnoses occurred in 38 individuals, and only 1 had PrEP in possession at diagnosis.
We observed PrEP care gaps and disparities among individuals referred for PrEP. Patient-centered interventions are needed in primary care to address barriers to successful PrEP linkage and persistence.
成功衔接暴露前预防（PrEP）并保持在医疗保健中对 HIV 预防至关重要。我们在美国的一个综合医疗保健系统中，研究了转诊后 PrEP 护理中的差距，以及与 PrEP 衔接和持续使用相关的因素。
我们使用电子健康记录，从 2014 年至 2017 年，在 Kaiser Permanente Southern California 确定了转诊接受 PrEP 的个人，并评估了在首次配药后一年中，与护理的衔接、PrEP 处方医嘱和配药，以及 PrEP 的持续使用（药物持有率≥80%）。我们使用一系列多变量修正泊松回归模型，评估了与 PrEP 衔接和持续使用相关的潜在人口统计学和临床因素。
在 2995 名转诊者中，74.9%的人成功与 PrEP 护理衔接。几乎所有与护理衔接的人都被开了 PrEP 处方并配了药，但只有 47.4%的配药者在 PrEP 上持续使用。与≥25 岁的人相比，年龄<25 岁（vs ≥25 岁）、女性（vs 男性）和有高免赔额保险（vs 无高免赔额）的人更不可能与护理衔接。年龄<25 岁和西班牙裔（vs 非西班牙裔白人）的人更不可能持续使用。有酒精使用障碍的人更有可能与 PrEP 护理衔接，但不太可能持续使用。有 38 人新诊断出 HIV，只有 1 人在诊断时拥有 PrEP。
我们观察到接受 PrEP 转诊的个体中存在 PrEP 护理差距和差异。初级保健中需要以患者为中心的干预措施，以解决成功衔接和持续使用 PrEP 的障碍。
