From the University of Texas Southwestern Medical Center (MGL); Parkland Health, Center of Innovation and Value, University of Texas Southwestern Medical Center (KSA, MH); Department of Family and Community Medicine, University of Texas Southwestern Medical Center (MS, ELK); College of Medicine, Department of Psychiatry, University of Kentucky (EMA); Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center (HLK).
J Am Board Fam Med. 2024 Mar-Apr;37(2):261-269. doi: 10.3122/jabfm.2023.230297R2.
HIV pre-exposure prophylaxis (PrEP) is effective at reducing HIV transmission. However, PrEP uptake is low for racial and ethnic minorities and women, especially in the Southern US Health care clinicians should be prepared to identify all patients eligible for PrEP, provide counseling, and prescribe PrEP.
Retrospective analysis of persons newly diagnosed with HIV was conducted at a large public health system from January 2015 to June 2021. Interactions with the health system in the 5 years preceding HIV diagnosis were analyzed, and missed opportunities for HIV prevention interventions, including PrEP and condom use counseling, were identified.
We identified 454 patients with a new HIV diagnosis with previous health system interactions. 166(36.6%) had at least 1 identifiable indication for PrEP: 42(9.3%) bacterial STI, 63(13.9%) inconsistent condom use, or 82(18%) injection drug use before HIV diagnosis. Only 7(1.5%) of patients were counseled on PrEP. Most patients (308; 67.8%) had no documented condom use history in the EHR before diagnosis, a surrogate marker for obtaining a sexual history. Patients who exclusively interacted with the emergency care setting did not receive PrEP education and were less likely to receive condom use counseling.
Missed opportunities to offer HIV prevention before diagnosis were common among patients newly diagnosed with HIV. Most patients did not have sexual history documented in the chart before their HIV diagnosis. Educational interventions are needed to ensure that clinicians are prepared to identify those eligible and discuss the benefits of PrEP.
艾滋病毒暴露前预防（PrEP）在降低艾滋病毒传播方面非常有效。然而，在种族和族裔少数群体以及女性中，PrEP 的使用率仍然很低，尤其是在美国南部。医疗保健临床医生应该准备好识别所有符合 PrEP 条件的患者，提供咨询，并开具 PrEP 处方。
对 2015 年 1 月至 2021 年 6 月期间在一个大型公共卫生系统中初次诊断出艾滋病毒的患者进行了回顾性分析。分析了在艾滋病毒诊断前的 5 年内与卫生系统的相互作用，并确定了预防艾滋病毒干预措施的错失机会，包括 PrEP 和避孕套使用咨询。
我们确定了 454 名新诊断出 HIV 的患者，他们之前与卫生系统有过互动。166 人（36.6%）至少有 1 个可识别的 PrEP 指征：42 人（9.3%）患有细菌性性传播感染，63 人（13.9%）避孕套使用不规律，或 82 人（18%）在 HIV 诊断前有注射吸毒史。只有 7 人（1.5%）接受了 PrEP 咨询。大多数患者（308 人；67.8%）在诊断前的电子健康记录中没有记录避孕套使用史，这是获得性病史的替代指标。仅与急诊环境互动的患者没有接受 PrEP 教育，接受避孕套使用咨询的可能性也较小。
在诊断前提供艾滋病毒预防措施的错失机会在新诊断出 HIV 的患者中很常见。大多数患者在 HIV 诊断前的图表中没有性病史记录。需要进行教育干预，以确保临床医生能够识别符合条件的患者，并讨论 PrEP 的益处。
