Merck & Co., Inc, Rahway, New Jersey, USA.
Adelphi Real World, Bollington, UK.
HIV Res Clin Pract. 2024 Dec;25(1):2382552. doi: 10.1080/25787489.2024.2382552. Epub 2024 Aug 8.
Uptake of pre-exposure prophylaxis (PrEP) in the United States (US) remains below target, despite reported high efficacy in prevention of HIV infection and being considered as a strategy for ending new HIV transmissions. Here, we sought to investigate drivers for PrEP use and barriers to increased uptake using real-world data. Data were drawn from the Adelphi PrEP Disease Specific Programme, a cross-sectional survey of PrEP users and PrEP non-users at risk for HIV and their physicians in the US between August 2021 and March 2022. Physicians reported demographic data, clinical characteristics, and motivations for prescribing PrEP. PrEP users and non-users reported reasons for or against PrEP use, respectively. Bivariate analyses were performed to compare characteris tics of users and non-users. In total, 61 physicians reported data on 480 PrEP users and 121 non-users. Mean ± standard deviation of age of users and non-users was 35.3 ± 10.8 and 32.5 ± 10.8 years, respectively. Majority were male and men who have sex with men. Overall, 90.0% of users were taking PrEP daily and reported fear of contracting HIV (79.0%) and having at-risk behaviors as the main drivers of PrEP usage. About half of non-users (49.0%) were reported by physicians as choosing not to start PrEP due to not wanting long-term medication. PrEP stigma was a concern for both users (50.0%) and non-users (65.0%). More than half felt that remembering to take PrEP (57.0%) and the required level of monitoring (63.0%) were burdensome. Almost half of people at risk for HIV were not taking PrEP due to not wanting long-term daily medication and about half of current PrEP users were not completely adherent. The most common reason for suboptimal adherence was forgetting to take medication. This study highlighted drivers for PrEP uptake from physician, PrEP user, and non-user perspectives as well as the attributes needed in PrEP products to aid increased PrEP uptake.
在美国，尽管已报告暴露前预防（PrEP）在预防艾滋病毒感染方面具有高度有效性，并被认为是终结新的艾滋病毒传播的策略，但 PrEP 的使用率仍低于目标水平。在这里，我们试图利用真实世界的数据来研究 PrEP 使用的驱动因素和增加使用率的障碍。
数据来自 Adelphi PrEP 疾病专项计划，这是一项在美国进行的针对 PrEP 使用者和有 HIV 感染风险的 PrEP 非使用者及其医生的横断面调查，时间为 2021 年 8 月至 2022 年 3 月。医生报告了人口统计学数据、临床特征以及开具 PrEP 处方的动机。PrEP 使用者和非使用者分别报告了支持或反对使用 PrEP 的原因。进行了单变量分析，以比较使用者和非使用者的特征。
总共有 61 名医生报告了 480 名 PrEP 使用者和 121 名非使用者的数据。使用者和非使用者的年龄分别为 35.3±10.8 岁和 32.5±10.8 岁。大多数为男性和男男性行为者。总体而言，90.0%的使用者每天都在服用 PrEP，他们报告说担心感染艾滋病毒（79.0%）和有高危行为是他们使用 PrEP 的主要动机。大约一半的非使用者（49.0%）被医生报告称由于不想长期服药而选择不开始服用 PrEP。PrEP 污名化是使用者（50.0%）和非使用者（65.0%）共同关注的问题。超过一半的人认为记住服用 PrEP（57.0%）和所需的监测水平（63.0%）是负担。
近一半有 HIV 感染风险的人因为不想长期每天服药而未服用 PrEP，而大约一半的现用 PrEP 使用者的依从性并不完全。最常见的不依从原因是忘记服药。本研究从医生、PrEP 使用者和非使用者的角度强调了 PrEP 使用率的驱动因素，以及 PrEP 产品需要具备的属性，以帮助提高 PrEP 使用率。
