University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH, USA.
Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA; University of Cincinnati, Departments of Psychology & Psychiatry and Behavioral Neuroscience, Cincinnati, OH, USA.
Am J Emerg Med. 2021 Oct;48:198-202. doi: 10.1016/j.ajem.2021.04.087. Epub 2021 May 4.
Pre-exposure prophylaxis (PrEP) is a highly effective but underutilized method of HIV prevention. Emergency departments (EDs) have access to at-risk populations meeting CDC eligibility criteria for PrEP. Characterizing this population could help motivate, develop, and implement ED interventions to promote PrEP uptake.
This cross-sectional study explored the proportion of patients from an urban, academic ED who met CDC 2017 PrEP eligibility criteria using three existing datasets that mimic patient selection strategies for HIV screening: 1) study of consecutively approached ED patients from 2008 to 2009 (analogous to non-targeted screening), 2) patients of the ED's HIV screening program in 2017 (analogous to risk-targeted screening), and 3) electronic health record (EHR) diagnostic codes in 2017 (analogous to EHR selected screening). The primary outcome was the proportion eligible for PrEP referral. Secondary outcomes included proportion by risk group: men who have sex with men (MSM), heterosexual men and women (HMW), and persons who inject drugs (PWID).
The proportion eligible for PrEP was: 568/1970 (28.8%, 95% CI: 26.9-30.9) for consecutively approached patients, 552/3884 (14%, 95% CI: 13-15) for risk-targeted patients, and 605/66287 (0.9%, 95% CI: 0.8-1.0) for EHR diagnoses of all patients. For the two datasets with behavioral risk information, the proportion eligible was: MSM 1-2%, HMW 12-28%, and PWID 1-4%.
A large subgroup of this ED population was eligible for PrEP referral. EDs are a compelling setting for development and implementation of HIV prevention interventions to assist in national efforts to expand PrEP.
暴露前预防（PrEP）是一种非常有效的但利用率低的艾滋病预防方法。急诊部门（EDs）可以接触到符合疾病预防控制中心（CDC）PrEP 资格标准的高危人群。对这一人群进行描述可以帮助激励、制定和实施 ED 干预措施，以促进 PrEP 的采用。
本横断面研究使用三个现有的数据集来探索从一个城市的学术急诊部连续就诊的患者中符合 2017 年 CDC PrEP 资格标准的患者比例，这些数据集模拟了 HIV 筛查的患者选择策略：1）2008 年至 2009 年连续就诊的 ED 患者的研究（类似于非目标筛查），2）2017 年 ED 的 HIV 筛查计划的患者（类似于风险目标筛查），和 3）2017 年电子健康记录（EHR）诊断代码（类似于 EHR 选择的筛查）。主要结果是有资格接受 PrEP 转诊的比例。次要结果包括按风险组划分的比例：男男性行为者（MSM）、异性恋男性和女性（HMW）和注射毒品者（PWID）。
有资格接受 PrEP 转诊的比例分别为：连续就诊的患者中 568/1970（28.8%，95%置信区间：26.9-30.9），风险目标患者中 552/3884（14%，95%置信区间：13-15），以及所有患者的 EHR 诊断中 605/66287（0.9%，95%置信区间：0.8-1.0）。对于有行为风险信息的两个数据集，有资格的比例分别为：MSM 1-2%，HMW 12-28%，和 PWID 1-4%。
该 ED 人群中有很大一部分亚组有资格接受 PrEP 转诊。ED 是制定和实施 HIV 预防干预措施的有力场所，有助于国家扩大 PrEP 的努力。
