Department of Global Health and Population, Harvard T.H. Chan School of Public Health.
The Fenway Institute, Fenway Health.
AIDS. 2024 Mar 1;38(3):415-420. doi: 10.1097/QAD.0000000000003774. Epub 2023 Nov 21.
The aim of this study was to assess HIV preexposure prophylaxis (PrEP) provision in U.S. health centers.
The U.S. Ending the HIV Epidemic (EHE) initiative designated health centers as the main healthcare system through which PrEP scale-up occurs. Health centers offer primary care to over 30 million disproportionately uninsured, racially or ethnically minoritized, and low-income patients. This study is the first to assess PrEP provision across health centers, including characteristics of clinics, patient populations, and policies associated with PrEP prescribing.
The Health Resources and Services Administration's Uniform Data System contained aggregate data on PrEP prescriptions and patient sociodemographics at health centers from January 1 through December 31, 2021, in 50 U.S. states, the District of Columbia, and eight U.S. territories. We compared patient demographics and availability of Medicaid expansion and PrEP assistance programs at health centers that prescribed vs. those that did not prescribe PrEP.
Across 1375 health centers serving 30 193 278 patients, 79 163 patients were prescribed PrEP. Health centers that prescribed any PrEP had higher proportions of sexual, gender, racial, and ethnic minority patient populations compared with health centers that prescribed no PrEP. Compared with health centers that prescribed no PrEP, a higher proportion of health centers that prescribed PrEP were located in designated high-priority jurisdictions of the EHE initiative or states with Medicaid expansion or public PrEP assistance programs.
Health centers are critical for scaling up PrEP in minoritized populations disproportionately affected by HIV, facilitated through federal and state-level policies. These findings highlight service gaps and inform future interventions to optimize PrEP implementation and support EHE initiative goals.
本研究旨在评估美国卫生中心提供的艾滋病毒暴露前预防（PrEP）。
美国终结艾滋病毒流行（EHE）倡议指定卫生中心为主要医疗保健系统，通过该系统扩大 PrEP 的规模。卫生中心为数以百万计的没有保险、种族或族裔少数群体、低收入的患者提供初级保健。本研究首次评估了整个卫生中心的 PrEP 供应情况，包括诊所的特点、患者人群以及与 PrEP 处方相关的政策。
卫生资源和服务管理局的统一数据系统包含了 2021 年 1 月 1 日至 12 月 31 日期间，50 个州、哥伦比亚特区和 8 个美国领土的卫生中心 PrEP 处方和患者社会人口统计学数据的汇总数据。我们比较了在有或没有开具 PrEP 处方的卫生中心，患者的人口统计学特征以及医疗补助扩大和 PrEP 援助计划的可用性。
在为 30193278 名患者提供服务的 1375 个卫生中心中，有 79163 名患者开具了 PrEP 处方。与没有开具 PrEP 处方的卫生中心相比，开具任何 PrEP 处方的卫生中心的性、性别、种族和族裔少数患者人群比例更高。与没有开具 PrEP 处方的卫生中心相比，开具 PrEP 处方的卫生中心中有更高比例的卫生中心位于 EHE 倡议的指定高优先级司法管辖区，或在有医疗补助扩大或公共 PrEP 援助计划的州。
卫生中心在为受艾滋病毒影响不成比例的少数群体扩大 PrEP 方面发挥了关键作用，这得益于联邦和州一级的政策。这些发现突出了服务差距，并为优化 PrEP 实施和支持 EHE 倡议目标提供了未来干预措施的信息。
