支持客户 HIV 自我检测的差异化直接到药房 PrEP 续药访问对就诊时间和早期 PrEP 延续的影响。

Effect of differentiated direct-to-pharmacy PrEP refill visits supported with client HIV self-testing on clinic visit time and early PrEP continuation.

机构信息

Department of Epidemiology, University of Washington, Seattle, Washington, USA.

Department of Global Health, University of Washington, Seattle, Washington, USA.

出版信息

J Int AIDS Soc. 2024 Mar;27(3):e26222. doi: 10.1002/jia2.26222.

DOI:10.1002/jia2.26222

PMID:38446643

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10935714/

Abstract

INTRODUCTION

Delivery of oral pre-exposure prophylaxis (PrEP) is being scaled up in Africa, but clinic-level barriers including lengthy clinic visits may threaten client continuation on PrEP.

METHODS

Between January 2020 and January 2022, we conducted a quasi-experimental evaluation of differentiated direct-to-pharmacy PrEP refill visits at four public health HIV clinics in Kenya. Two clinics implemented the intervention package, which included direct-to-pharmacy for PrEP refill, client HIV self-testing (HIVST), client navigator, and pharmacist-led rapid risk assessment and dispensing. Two other clinics with comparable size and client volume served as contemporaneous controls with the usual clinic flow. PrEP continuation was evaluated by visit attendance and pharmacy refill records, and time and motion studies were conducted to determine time spent in the clinics. Dried blood spots were collected to test for tenofovir-diphosphate (TFV-DP) at random visits. We used logistic regression to assess the intervention effect on PrEP continuation and the Wilcoxon rank sum test to assess the effect on clinic time.

RESULTS

Overall, 746 clients were enrolled, 366 at control clinics (76 during pre-implementation and 290 during implementation phase), and 380 at direct-to-pharmacy clinics (116 during pre-implementation and 264 during implementation phase). Prior to implementation, the intervention and control clinics were comparable on client characteristics (female: 51% vs. 47%; median age: 33 vs. 33 years) and PrEP continuation (35% vs. 37% at 1 month, and 37% vs. 39% at 3 months). The intervention reduced total time spent at the clinic by 35% (median of 51 minutes at control vs. 33 minutes at intervention clinics; p<0.001), while time spent on HIV testing (20 vs. 20 minutes; p = 0.50) and pharmacy (8 vs. 8 minutes; p = 0.8) was unchanged. PrEP continuation was higher at intervention versus the control clinics: 45% versus 33% at month 1, 34% versus 25% at month 3 and 23% versus 16% at month 6. TFV-DP was detected in 85% (61/72) of samples, similar by the study group (83% vs. 85%).

CONCLUSIONS

A client-centred PrEP delivery approach with direct-to-pharmacy PrEP refill visits plus client HIVST significantly reduced clinic visit time by more than one-third and improved PrEP continuation in public health HIV clinics in Kenya.

摘要

简介

在非洲，口服暴露前预防（PrEP）的提供正在扩大，但包括就诊时间长在内的诊所层面的障碍可能会威胁到客户继续使用 PrEP。

方法

在 2020 年 1 月至 2022 年 1 月期间，我们在肯尼亚的四家公共卫生艾滋病毒诊所进行了一项差异化直接到药房 PrEP 续药就诊的准实验评估。两家诊所实施了干预方案，其中包括直接到药房续药 PrEP、客户艾滋病毒自检（HIVST）、客户导航员和药剂师主导的快速风险评估和配药。另外两家规模和客户量相当的诊所作为同期对照组，采用常规诊所流程。通过就诊 attendance 和药房 refill 记录评估 PrEP 续用情况，通过时间和运动研究确定在诊所花费的时间。在随机就诊时采集干血斑，检测替诺福韦二磷酸酯（TFV-DP）。我们使用逻辑回归评估干预对 PrEP 续用的影响，使用 Wilcoxon 秩和检验评估对诊所时间的影响。

结果

共有 746 名患者入组，其中 366 名在对照组诊所（实施前 76 名，实施后 290 名），380 名在直接到药房诊所（实施前 116 名，实施后 264 名）。在实施前，干预组和对照组在患者特征（女性：51% vs. 47%；中位年龄：33 岁 vs. 33 岁）和 PrEP 续用率（1 个月时 35% vs. 37%，3 个月时 37% vs. 39%）方面无差异。该干预措施使诊所总就诊时间减少了 35%（对照组中位数为 51 分钟，干预组为 33 分钟；p<0.001），而艾滋病毒检测（20 分钟对 20 分钟；p = 0.50）和药房（8 分钟对 8 分钟；p = 0.8）时间无变化。与对照组相比，干预组的 PrEP 续用率更高：第 1 个月时为 45% vs. 33%，第 3 个月时为 34% vs. 25%，第 6 个月时为 23% vs. 16%。在 72 份样本中，有 85%（61/72）检测到 TFV-DP，研究组的检测结果相似（83% vs. 85%）。