2011-2021 年澳大利亚墨尔本一家性健康诊所引入 HIV 暴露前预防措施前后 HIV 暴露后预防处方的变化。

Changes in HIV post-exposure prophylaxis prescriptions before and after the introduction of HIV pre-exposure prophylaxis at a sexual health clinic in Melbourne, Australia, 2011-2021.

机构信息

Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Hospital, Alfred Health, Melbourne, Victoria, Australia.

Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.

出版信息

Aust N Z J Public Health. 2024 Aug;48(4):100179. doi: 10.1016/j.anzjph.2024.100179. Epub 2024 Jul 24.

DOI:10.1016/j.anzjph.2024.100179

PMID:39053109

Abstract

OBJECTIVE

HIV pre-exposure prophylaxis (PrEP) became available in Victoria, Australia, in 2016. We examined non-occupational post-exposure prophylaxis (nPEP) usage among gay, bisexual and other men who have sex with men (MSM) before and after PrEP became available.

METHODS

We included MSM attending Melbourne Sexual Health Centre for nPEP between 2011 and 2021. We analysed three periods: the 'pre-PrEP' (01 Jan 2011 to 25 Jul 2016), 'PrEP before COVID-19' (26 Jul 2016 to 31 Dec 2019), and 'PrEP during COVID-19' (01 Jan 2020 to 31 Dec 2021).

RESULTS

There were 222,978 consultations for MSM; 8292 (3.7%) were nPEP consultations. The proportion of nPEP consultations increased from 3.3% (3093/94263) in the pre-PrEP period to 4.3% (3843/89251) in the PrEP before COVID-19 period then dropped to 3.4% (1356/39464) during the COVID-19 period. Compared to Australian-born MSM, MSM born in Central/South America (adjusted odds ratio [aOR]: 1.75; 95% confidence interval [CI]: 1.27-2.40) had the highest odds of accessing nPEP, followed by Asian-born MSM (aOR: 1.47; 95% CI: 1.27-1.71) after adjusting for PrEP availability and COVID-19. Those newly arrived in Australia in ≤4 years had higher odds (aOR: 1.14; 95% CI: 1.05-1.22) of accessing nPEP than those living in Australia for >4 years.

CONCLUSION

nPEP prescriptions declined with PrEP availability. Newly arrived overseas-born MSM who are unlikely to have access to subsidised PrEP have a higher demand of nPEP.

IMPLICATIONS FOR PUBLIC HEALTH

Increasing PrEP education and ensuring equal access is vital in the drive to reduce new HIV diagnoses.

摘要

目的

2016 年，澳大利亚维多利亚州开始提供艾滋病毒暴露前预防（PrEP）。本研究旨在探讨 PrEP 供应前后男同性恋、双性恋和其他男男性行为者（MSM）的非职业性暴露后预防（nPEP）使用情况。

方法

我们纳入了 2011 年至 2021 年间在墨尔本性健康中心接受 nPEP 的 MSM。我们分析了三个时期：“PrEP 前”（2011 年 1 月 1 日至 2016 年 7 月 25 日）、“PrEP 前 COVID-19”（2016 年 7 月 26 日至 2019 年 12 月 31 日）和“PrEP 期间 COVID-19”（2020 年 1 月 1 日至 2021 年 12 月 31 日）。

结果

共 222978 次 MSM 就诊，其中 8292 次（3.7%）为 nPEP 就诊。nPEP 就诊比例从 PrEP 前时期的 3.3%（3093/94263）增加到 PrEP 前 COVID-19 时期的 4.3%（3843/89251），然后在 COVID-19 时期降至 3.4%（1356/39464）。与澳大利亚出生的 MSM 相比，中/南美洲出生的 MSM（调整后的优势比[aOR]：1.75；95%置信区间[CI]：1.27-2.40）获得 nPEP 的可能性最高，其次是亚洲出生的 MSM（aOR：1.47；95% CI：1.27-1.71），调整了 PrEP 供应和 COVID-19 后。在澳大利亚居住≤4 年的新移民获得 nPEP 的几率（aOR：1.14；95% CI：1.05-1.22）高于在澳大利亚居住>4 年的移民。