基于社区药店的暴露前预防（PrEP）递送方案的偏好：一项离散选择实验。

Preferences for a community pharmacy-based pre-exposure prophylaxis (PrEP) delivery program: A discrete choice experiment.

出版信息

J Am Pharm Assoc (2003). 2024 Jul-Aug;64(4):102091. doi: 10.1016/j.japh.2024.102091. Epub 2024 Apr 9.

DOI:10.1016/j.japh.2024.102091

Abstract

BACKGROUND

Community pharmacies are ideal venues for pre-exposure prophylaxis (PrEP) delivery. Pharmacists and pharmacy-based PrEP delivery programs have the potential to improve access.

OBJECTIVES

This study elicited preferences for attributes of a hypothetical community pharmacy-based PrEP delivery program among US men who have sex with men (MSM) and assessed predictors of their preferences.

METHODS

Data were collected via a cross-sectional anonymous survey of US MSM, who were aged 18-65 years, not transgender, reported HIV status negative/unknown, and PrEP eligible. A discrete choice experiment was conducted with seven attributes of a pharmacy-based PrEP program: initial PrEP eligibility screening mode, location for human immunodeficiency virus (HIV) tests, timing for HIV test results, PrEP decision-making style, location of PrEP consultations, PrEP medication fill method, and mode for ongoing monitoring. Latent class analysis was performed to analyze preference heterogeneity. Multinomial logistic regression assessed predictors of latent class membership.

RESULTS

This study included 390 MSM. Time to receive HIV test results was the most important attribute; receiving results on the same day had the highest preference. The next most important attribute was PrEP screening mode; online questionnaires were the most preferred. Respondents' preferences clustered into four classes: 1) "Same day results and online monitoring" (SDROM) group (63.1%), 2) "Consumerist decision-making" (CDM) group (16.2%), 3) "Self-screening (online questionnaire)" (SOQ) group (11.3%), and 4) "Same day results preferring" (SDRP) group (9.5%). Hispanic MSM (adjusted odds ratio [aOR] =0.31, 95% confidence interval [CI] [0.12-0.84], P = 0.020), MSM of other races (aOR=0.38, 95% CI [0.15-0.97], P = 0.044) vs. White MSM; and those having a sexually transmitted disease recently (aOR=0.37, 95% CI [0.16-0.85], P = 0.018), had lower odds of being in the CDM group vs. the SDROM group.

CONCLUSIONS

MSM's preferences for a pharmacy-based PrEP program are heterogeneous. Same day results for HIV tests and online PrEP screening are key components when designing a community pharmacy-based PrEP program.

摘要

背景

社区药房是提供暴露前预防（PrEP）的理想场所。药剂师和基于药房的 PrEP 提供方案有潜力改善获取途径。

目的

本研究旨在了解美国男男性行为者（MSM）对假设的基于社区药房的 PrEP 提供方案的属性偏好，并评估其偏好的预测因素。

方法

通过对年龄在 18-65 岁、非跨性别、报告 HIV 检测结果为阴性/未知且符合 PrEP 条件的美国 MSM 进行横断面匿名调查收集数据。采用离散选择实验对基于药房的 PrEP 方案的七个属性进行评估：初始 PrEP 资格筛选模式、艾滋病毒（HIV）检测地点、HIV 检测结果时间、PrEP 决策风格、PrEP 咨询地点、PrEP 药物配药方法和持续监测方式。采用潜在类别分析（Latent Class Analysis）分析偏好异质性。多变量逻辑回归评估潜在类别成员的预测因素。

结果

本研究纳入了 390 名 MSM。获得 HIV 检测结果的时间是最重要的属性；当天获得结果的偏好最高。下一个最重要的属性是 PrEP 筛查模式；在线问卷是最受欢迎的。受访者的偏好聚类为四个类别：1）“当天结果和在线监测”（SDROM）组（63.1%），2）“消费者决策”（CDM）组（16.2%），3）“自我筛查（在线问卷）”（SOQ）组（11.3%），和 4）“当天结果偏好”（SDRP）组（9.5%）。西班牙裔 MSM（调整后的优势比[aOR]为 0.31，95%置信区间[CI] [0.12-0.84]，P=0.020），非白种人 MSM（aOR=0.38，95%CI [0.15-0.97]，P=0.044）与白种人 MSM 相比；以及最近患有性传播疾病的人（aOR=0.37，95%CI [0.16-0.85]，P=0.018）与 SDROM 组相比，他们成为 CDM 组的可能性较低。