Unigwe Ikenna F, Cook Robert L, Janelle Jennifer W, Park Haesuk
Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida.
Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida.
AJPM Focus. 2023 Jul 30;2(4):100134. doi: 10.1016/j.focus.2023.100134. eCollection 2023 Dec.
To ensure the health and safety of persons taking pre-exposure prophylaxis to prevent HIV infection, the 2017 Centers for Disease Control and Prevention guidelines recommended initial and follow-up laboratory testing. We assessed the trends in adherence rates to recommended laboratory testing among pre-exposure prophylaxis users and identified factors associated with HIV testing among pre-exposure prophylaxis users from 2016 to 2020 and also examined rate changes during the COVID-19 pandemic in 2020.
We conducted a retrospective cohort study assessing the rates and trends of recommended laboratory testing among commercially insured pre-exposure prophylaxis users from 2016 to 2020, using the MarketScan database. We examined the proportion of pre-exposure prophylaxis users adhering to the following initial and follow-up laboratory testing: (1) HIV, creatinine clearance, hepatitis B virus, hepatitis C virus, and sexually transmitted infections (chlamydia/gonorrhea and syphilis) within 7 days before pre-exposure prophylaxis initiation; (2) HIV 90 days after initiation; and (3) HIV, creatinine clearance, and sexually transmitted infections 180 days after pre-exposure prophylaxis initiation. We used general linear models to examine trends and multivariable logistic regression to identify predictors of ≥1 HIV test within 180 days after index pre-exposure prophylaxis.
We identified 19,581 new pre-exposure prophylaxis users. Most were male (96%) and aged 18-34 years (55%). Adherence rates to recommended testing increased from 2016 through 2019 (e.g., 9.0%-13.6% for all initial screening tests 7 days before initiation, 42.1%-44.6% for HIV testing 90 days after initiation, 33.8%-40.6% for all follow-up tests within 180 days after initiation), but all rates decreased during the COVID-19 pandemic (12.4%, 33.6%, and 31.6%, respectively). Younger age (aged 13-17 years: AOR=0.44, 95% CI=0.28, 0.71) and ages 18-34 years (AOR=0.80, 95% CI=0.74, 0.86) were associated with a significantly lower likelihood of getting an HIV test within 180 days after initiation than ages 35-44 years, and female sex (AOR=0.64, 95% CI=0.55, 0.74) were associated with a significantly lower likelihood than male sex. Pre-exposure prophylaxis users with a history of sexually transmitted infections had a higher likelihood (AOR=1.27, 95% CI=1.16, 1.40) of getting tested than those without.
Initial screening and follow-up testing rates were lower than those recommended by the Centers for Disease Control and Prevention. Public health efforts are needed to ensure that patients have access to needed laboratory testing during pandemics or natural disasters and to educate patients and clinicians about the importance of screening and monitoring tests to ensure the safety and health of pre-exposure prophylaxis users.
为确保采用暴露前预防措施预防HIV感染的人群的健康与安全，2017年美国疾病控制与预防中心指南建议进行初次及后续实验室检测。我们评估了暴露前预防措施使用者对推荐实验室检测的依从率趋势，并确定了2016年至2020年期间暴露前预防措施使用者中与HIV检测相关的因素，还研究了2020年新冠疫情期间的比率变化。
我们开展了一项回顾性队列研究，利用MarketScan数据库评估2016年至2020年期间商业保险的暴露前预防措施使用者中推荐实验室检测的比率及趋势。我们检查了暴露前预防措施使用者遵守以下初次及后续实验室检测的比例：（1）在开始暴露前预防措施前7天内进行HIV、肌酐清除率、乙型肝炎病毒、丙型肝炎病毒和性传播感染（衣原体/淋病和梅毒）检测；（2）开始后90天进行HIV检测；（3）开始暴露前预防措施后180天进行HIV、肌酐清除率和性传播感染检测。我们使用一般线性模型来检查趋势，并使用多变量逻辑回归来确定在初次暴露前预防措施后180天内进行≥1次HIV检测的预测因素。
我们确定了19581名新的暴露前预防措施使用者。大多数为男性（96%），年龄在18 - 34岁之间（55%）。从2016年到2019年，对推荐检测的依从率有所上升（例如，开始前7天所有初次筛查检测的依从率为9.0% - 13.6%，开始后90天HIV检测的依从率为42.1% - 44.6%，开始后180天内所有后续检测的依从率为33.8% - 40.6%），但在新冠疫情期间所有比率均下降（分别为12.4%、33.6%和31.6%）。年龄较小（13 - 17岁：调整后比值比[AOR]=0.44，95%置信区间[CI]=0.28, 0.71）以及18 - 34岁（AOR=0.80，95% CI=0.74, 0.86）的使用者在开始后180天内进行HIV检测的可能性显著低于35 - 44岁的使用者，女性（AOR=0.64，95% CI=0.55, 0.74）进行检测的可能性显著低于男性。有性传播感染病史的暴露前预防措施使用者接受检测的可能性高于无病史者（AOR=1.27，95% CI=1.16, 1.40）。
初次筛查和后续检测率低于疾病控制与预防中心的推荐水平。需要开展公共卫生工作，以确保患者在大流行或自然灾害期间能够进行所需的实验室检测，并教育患者和临床医生有关筛查和监测检测对于确保暴露前预防措施使用者的安全与健康的重要性。
