一项针对青少年和年轻成年人将阿片类药物使用障碍治疗药物和 HIV 暴露前预防药物整合的障碍和促进因素的定性研究。
A Qualitative Study of Barriers and Facilitators to Integrating Medications for Opioid Use Disorder and HIV Preexposure Prophylaxis for Adolescents and Young Adults.
机构信息
From the Division of Adolescent Medicine, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (MCH, KD); Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (SW, ND); Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children/Harvard Medical School, Boston, MA (SEH); and Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania (DM).
出版信息
J Addict Med. 2023;17(6):e349-e354. doi: 10.1097/ADM.0000000000001195. Epub 2023 Jun 22.
BACKGROUND
The syndemic of substance use and human immunodeficiency virus (HIV) is a well-recognized global phenomenon that threatens to undermine the priorities outlined by the National Institutes of Health "Ending the HIV Epidemic" initiative. There are few published studies on preexposure prophylaxis (PrEP) for adolescents and young adults (AYAs) with opioid use disorder (OUD) despite increasing availability of biomedical prevention options and Centers for Disease Control and Prevention recommendations to offer PrEP to this group.
METHODS
Healthcare providers who previously prescribed medications for OUD (MOUDs) and/or PrEP for AYA were purposively sampled. Audio-recorded in-depth individual interviews were conducted using chart-stimulated recall to explore barriers and facilitators to integrated MOUD and HIV prevention services. Interviews were double-coded, and qualitative analysis was performed using a modified grounded theory.
RESULTS
Of 19 providers sampled, most were physicians (63%). All recommended HIV screening at varying intervals; however, few counseled on (19%) or prescribed (11%) PrEP to patients on MOUD. Barriers to PrEP prescriptions included patient-level (ie, stigma surrounding PrEP use, adherence challenges, and competing social or mental healthcare needs), provider (perception of low risk, lack of training/experience), and system-level factors (including restricted visit types). Facilitators of PrEP prescriptions included patient-initiated requests, electronic health record system reminders, and the availability of consistent support staff (ie, navigators, certified recovery specialists).
CONCLUSIONS
Our study confirms that discussions about HIV prevention and PrEP prescriptions may be rare for AYA patients receiving MOUD. Further research is needed to develop interventions that increase the integration of PrEP delivery within the context of OUD care among this key AYA population.
背景
物质使用和人类免疫缺陷病毒（HIV）的综合征是一种公认的全球现象，它有可能破坏美国国立卫生研究院“终结艾滋病流行”计划中概述的重点。尽管有越来越多的生物医学预防选择和疾病控制与预防中心建议向该群体提供预防措施，但针对有阿片类药物使用障碍（OUD）的青少年和年轻成年人（AYAs）的暴露前预防（PrEP）的研究很少。
方法
专门选择了以前为 OUD（MOUDs）和/或 AYA 开具 PrEP 的医疗保健提供者。使用图表刺激回忆进行了音频记录的深入个人访谈，以探讨整合 MOUD 和 HIV 预防服务的障碍和促进因素。访谈进行了双重编码，并使用改进的扎根理论进行了定性分析。
结果
在 19 名抽样提供者中，大多数是医生（63％）。所有人都建议在不同的时间间隔进行 HIV 筛查；但是，很少有提供者对接受 MOUD 的患者进行 PrEP 咨询（19％）或开处方（11％）。PrEP 处方的障碍包括患者层面（例如，PrEP 使用的耻辱感，服药依从性挑战以及相互竞争的社会或心理健康保健需求），提供者（感知风险低，缺乏培训/经验）和系统层面的因素（包括有限的就诊类型）。PrEP 处方的促进因素包括患者主动提出要求，电子健康记录系统提醒以及始终如一的支持人员（例如，导航员，认证康复专家）的可用性。
结论
我们的研究证实，对于接受 MOUD 的 AYA 患者，关于 HIV 预防和 PrEP 处方的讨论可能很少。需要进一步研究以开发干预措施，以便在 OUD 护理背景下，将 PrEP 交付整合到这一关键 AYA 人群中。
Zotero 插件