Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Jamaica Plain.
Sex Transm Dis. 2022 Sep 1;49(9):657-661. doi: 10.1097/OLQ.0000000000001669. Epub 2022 Jul 4.
Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) reduces HIV acquisition. We used a PrEP continuum of care to measure impact of field epidemiologist-facilitated referrals for PrEP-naive infectious syphilis cases across multiple clinical and pharmacy sites of care.
Retrospective analysis of 2017 to 2018 primary and secondary syphilis cases, medical charts, and pharmacy data to identify PrEP education, referral offer, referral acceptance, first visit, prescription pickup (PrEP initiation) and 2 to 3 months (PrEP persistence). The HIV seroconversion was determined using database match at syphilis diagnosis date and at 12 months. χ 2 or Fisher's exact tests were used to compare demographic characteristics associated with steps with lower progression rates.
Of 1077 syphilis cases, partner services engaged 662 of 787 (84%) HIV-negative cases; 490 were PrEP-naive, 266 received education, 166 were offered referral, 67 accepted referral, 30 attended an initial appointment, and 22 were prescribed PrEP. Of 16 with pharmacy data, 14 obtained medication, and 8 persisted on PrEP at 2 to 3 months. Continuum progression was lowest from (1) PrEP-naïve to receiving PrEP education, (2) offered referral to referral acceptance, and (3) referral acceptance to initial PrEP appointment. Men with male partners were more likely to receive PrEP education or accept a referral. Higher social vulnerability was associated with increased PrEP referral acceptance.
Few individuals accepted PrEP referrals and persisted on PrEP. Field and clinic data capture were inconsistent, possibly underestimating referral volume and impact of field engagement. Efforts aimed at increasing referral acceptance and clinic attendance may improve PrEP uptake especially among women and heterosexual men with syphilis.
人类免疫缺陷病毒（HIV）暴露前预防（PrEP）可降低 HIV 感染率。我们使用 PrEP 连续护理来衡量传染病专家促进对多个临床和药房护理点的 PrEP 初治感染性梅毒病例的转介的影响。
对 2017 年至 2018 年原发性和继发性梅毒病例、病历和药房数据进行回顾性分析，以确定 PrEP 教育、转介提供、转介接受、首次就诊、处方取药（PrEP 起始）和 2 至 3 个月（PrEP 持续）。HIV 血清转换通过在梅毒诊断日期和 12 个月时使用数据库匹配来确定。χ 2 或 Fisher 精确检验用于比较与进展率较低相关的人口统计学特征。
在 1077 例梅毒病例中，伙伴服务机构接触了 787 例 HIV 阴性病例中的 662 例（84%）；490 例为 PrEP 初治者，266 例接受了教育，166 例被提供了转介，67 例接受了转介，30 例参加了首次就诊，22 例接受了 PrEP 处方。在有药房数据的 16 例中，14 例获得了药物，8 例在 2 至 3 个月时继续接受 PrEP。从（1）PrEP 初治者接受 PrEP 教育，（2）提供转介到接受转介，以及（3）接受转介到首次 PrEP 预约，连续护理的进展率最低。有男性性伴侣的男性更有可能接受 PrEP 教育或接受转介。较高的社会脆弱性与增加 PrEP 转介接受率有关。
只有少数人接受 PrEP 转介并坚持服用 PrEP。现场和诊所的数据采集不一致，可能低估了转介量和现场参与的影响。旨在提高转介接受率和诊所就诊率的努力可能会提高 PrEP 的使用率，特别是在感染梅毒的女性和异性恋男性中。
