Sandyford Initiative, NHS Greater Glasgow and Clyde, Glasgow, UK.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
HIV Med. 2021 Nov;22(10):965-970. doi: 10.1111/hiv.13181. Epub 2021 Sep 28.
HIV prevention strategies including pre-exposure prophylaxis (PrEP) must reach all in need to achieve elimination of transmission by 2030. Mainstream provision may inadvertently exclude key populations. Incidence of HIV in people who inject drugs (PWID) in Glasgow, Scotland's largest city, is increasing, partly due to sexual transmission. Scotland provides publicly funded oral PrEP for individuals at sexual risk of HIV through sexual health services; however, uptake by PWID has been negligible. We developed a tailored outreach PrEP service based in the local homeless health centre. We used active case finding, flexibility of assessment location, supervised community daily dispensing and active follow-up to optimise uptake and adherence. We describe a two-year service evaluation.
We reviewed the case records of all PWID identified by the outreach team as being at higher risk of sexual acquisition for whom PrEP was considered between November 2018 and November 2020. Evaluation focused on PrEP uptake, adherence and monitoring. We conducted a descriptive statistical analysis.
Of 41 PWID assessed as eligible, 32 (78.0%) commenced PrEP. The proportion of PrEP-covered days was 3320/3400 days (97.6%); 31/32 (96.9%) had regular HIV serology monitoring. The service was feasible to run, but it relied on outreach provision and liaison with other services.
Tailored PrEP services can reach PWID effectively. Uptake and adherence were high but the model was resource-intensive. Appropriately tailored PrEP delivery may be required to meet the needs of this and other key populations who experience barriers to accessing mainstream services.
包括暴露前预防（PrEP）在内的艾滋病毒预防策略必须覆盖所有有需要的人，才能在 2030 年实现传播的消除。主流服务可能会无意中将重点人群排除在外。在苏格兰最大城市格拉斯哥，注射吸毒者（PWID）的艾滋病毒发病率正在上升，部分原因是性传播。苏格兰通过性健康服务为有艾滋病毒性传播风险的个人提供公共资金支持的口服 PrEP；然而，PWID 的使用率却微不足道。我们在当地无家可归者健康中心建立了一个定制的外展 PrEP 服务。我们利用主动病例发现、评估地点的灵活性、社区监督的日常配药和积极的随访来优化使用率和坚持度。我们描述了为期两年的服务评估。
我们审查了外展团队确定的所有因性传播而处于更高艾滋病毒感染风险的 PWID 的病例记录，这些人被认为需要接受 PrEP 治疗，时间范围为 2018 年 11 月至 2020 年 11 月。评估重点是 PrEP 的使用率、坚持度和监测。我们进行了描述性统计分析。
在评估为符合条件的 41 名 PWID 中，有 32 名（78.0%）开始接受 PrEP。PrEP 覆盖天数为 3320/3400 天（97.6%）；31/32（96.9%）有定期的艾滋病毒血清学监测。该服务运行可行，但依赖于外展服务和与其他服务的联络。
定制的 PrEP 服务可以有效地覆盖 PWID。使用率和坚持度都很高，但该模式资源密集。可能需要适当定制 PrEP 的提供方式，以满足这些和其他面临主流服务障碍的重点人群的需求。
