Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX.
Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, TX.
J Acquir Immune Defic Syndr. 2021 Nov 1;88(3):e17-e21. doi: 10.1097/QAI.0000000000002767.
Safety-net health systems are key settings for HIV pre-exposure prophylaxis (PrEP) implementation, but little evidence is available about the frequency of PrEP prescribing in safety-net settings. We assessed PrEP prescribing among people with indications for PrEP at an urban safety-net health system that serves a county designated as an Ending the HIV Epidemic priority jurisdiction.
We identified adults (aged 18 years or older) who engaged in primary care between January 2015 and December 2019 and had a documented indication for PrEP. PrEP indications included the presence of a behavioral or sexual risk factor of HIV acquisition or a positive bacterial sexually transmitted infection at the index visit. PrEP prescribing was defined as the proportion of patients with indications for PrEP who received a new prescription for PrEP. We estimated the cumulative incidence of PrEP prescription with corresponding 95% confidence limits (CL).
Our study population comprised 2957 individuals, of whom 58% was aged younger than 45 years, 56% was women, 67% was racial or ethnic minorities, and 60% was uninsured or provided care as part of a hospital-based managed care plan for individuals without insurance. We identified 41 individuals who were prescribed PrEP. The cumulative incidence of PrEP prescribing within 1 year of the first documented PrEP indication was 1.3% (95% CL: 0.91% to 1.7%).
Our results suggest extremely low frequency of PrEP prescribing among people with indications for PrEP in an urban safety-net health system. Strategies are needed to improve PrEP implementation in high-priority populations and safety-net settings.
安全网卫生系统是实施艾滋病毒暴露前预防（PrEP）的关键场所，但关于安全网环境中 PrEP 处方的频率，证据有限。我们评估了在一个城市安全网卫生系统中，为一个被指定为终结艾滋病毒流行重点司法管辖区的县服务的有 PrEP 指征的人群中 PrEP 的处方情况。
我们确定了在 2015 年 1 月至 2019 年 12 月期间参与初级保健的成年人（年龄在 18 岁或以上），并记录了 PrEP 的指征。PrEP 指征包括存在艾滋病毒获得的行为或性风险因素，或在就诊时存在阳性细菌性性传播感染。PrEP 处方定义为有 PrEP 指征的患者中接受新的 PrEP 处方的比例。我们估计了 PrEP 处方的累积发生率，并给出了相应的 95%置信区间（CL）。
我们的研究人群包括 2957 人，其中 58%的年龄小于 45 岁，56%为女性，67%为少数族裔，60%无保险或通过医院管理式医疗计划为无保险者提供护理。我们发现有 41 人接受了 PrEP 处方。在首次记录 PrEP 指征后的 1 年内，PrEP 处方的累积发生率为 1.3%（95% CL：0.91%至 1.7%）。
我们的结果表明，在城市安全网卫生系统中，有 PrEP 指征的人群中 PrEP 处方的频率极低。需要采取策略来改善高危人群和安全网环境中的 PrEP 实施。
