Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts.
Center for Transgender Medicine and Surgery, Boston Medical Center, Massachusetts.
JAMA Netw Open. 2022 Jul 1;5(7):e2221346. doi: 10.1001/jamanetworkopen.2022.21346.
Although HIV preexposure prophylaxis (PrEP) implementation among persons who inject drugs has been inadequate, national HIV monitoring programs do not include data on PrEP, and specific trends in PrEP use are not well understood.
To estimate HIV PrEP uptake among commercially insured persons with opioid or stimulant use disorder by injection drug use (IDU) status.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used deidentified data from the MarketScan Commercial Claims and Encounters Database to identify a sample of 547 709 commercially insured persons without HIV but with opioid and/or stimulant use disorder, including 110 592 with evidence of IDU between January 1, 2010, and December 31, 2019. Data were analyzed from November 1, 2020, to July 1, 2021.
Persons with opioid and/or stimulant use disorder and evidence of IDU were identified through claims data.
The outcome was receipt of tenofovir disoproxil fumarate and emtricitabine for PrEP as identified from filled pharmacy claims. Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with receipt of PrEP.
The study cohort included 211 609 (28.6%) females and 336 100 (61.4%) males with a combined mean (SD) age of 34.8 (13.1) years, including 110 592 individuals with evidence of IDU. During the study period, 508 (0.09%) persons with opioid and/or stimulant use disorder, including 170 (0.15%) with evidence of IDU, received PrEP. Receipt of PrEP increased from 0.001 to 0.243 per 100 person-years from 2010 through 2019 among the entire cohort and from 0.000 to 0.295 per 100 person-years among those with IDU. In multivariable analysis, PrEP use was more likely among males (adjusted odds ratio [aOR] 8.72; 95% CI, 6.39-11.89), persons with evidence of IDU (aOR, 1.47; 95% CI, 1.21-1.79), and persons with evidence of sexual risk indications for PrEP (aOR, 23.68; 95% CI, 19.57-28.66).
In this cross-sectional study of commercially insured persons with opioid and/or stimulant use disorder, HIV PrEP delivery remained low, including among those with evidence of IDU. PrEP should be consistently offered alongside substance use disorder treatment and other harm reduction and HIV prevention services.
尽管在注射吸毒者中实施艾滋病毒暴露前预防 (PrEP) 的情况并不理想，但国家艾滋病毒监测计划并未包括关于 PrEP 的数据，也不了解 PrEP 使用的具体趋势。
根据注射吸毒者的状况，评估有阿片类药物或兴奋剂使用障碍的商业保险人群中艾滋病毒 PrEP 的使用率。
设计、地点和参与者：本横断面研究使用 MarketScan 商业索赔和就诊数据库的匿名数据，确定了一个由 547709 名无艾滋病毒但有阿片类药物和/或兴奋剂使用障碍的商业保险人群组成的样本，其中 110592 人在 2010 年 1 月 1 日至 2019 年 12 月 31 日期间有注射吸毒证据。数据分析于 2020 年 11 月 1 日至 2021 年 7 月 1 日进行。
通过索赔数据确定有阿片类药物和/或兴奋剂使用障碍且有注射吸毒证据的人群。
结果是根据填写的药房索赔确定的接受替诺福韦二吡呋酯和恩曲他滨的 PrEP 情况。多变量逻辑回归用于评估人口统计学和临床特征与 PrEP 使用率之间的关联。
研究队列包括 211609 名（28.6%）女性和 336100 名（61.4%）男性，平均（SD）年龄为 34.8（13.1）岁，其中包括 110592 名有注射吸毒证据的个体。在研究期间，508 名（0.09%）有阿片类药物和/或兴奋剂使用障碍的人，包括 170 名（0.15%）有注射吸毒证据的人，接受了 PrEP。在整个队列中，从 2010 年到 2019 年，PrEP 的使用从每 100 人年 0.001 增加到 0.243，在有注射吸毒证据的人群中，从每 100 人年 0.000 增加到 0.295。在多变量分析中，男性（调整后的优势比 [aOR]，8.72；95%CI，6.39-11.89）、有注射吸毒证据的人（aOR，1.47；95%CI，1.21-1.79）和有性风险迹象需要 PrEP 的人（aOR，23.68；95%CI，19.57-28.66）更有可能使用 PrEP。
在这项针对有阿片类药物和/或兴奋剂使用障碍的商业保险人群的横断面研究中，艾滋病毒 PrEP 的提供情况仍然很低，包括有注射吸毒证据的人群。PrEP 应与物质使用障碍治疗以及其他减少伤害和艾滋病毒预防服务一起持续提供。
