利用安德森医疗保健利用模型评估在基于药房的环境中对 cisgender 性少数男性进行 prep 筛查的意愿：来自 2020 年美国男性互联网调查的结果。
Using the andersen healthcare utilization model to assess willingness to screen for prep in pharmacy-based settings among cisgender sexually minoritized men: results from the 2020 american men's internet survey.
机构信息
Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, 30322, Atlanta, GA, United States.
出版信息
BMC Public Health. 2024 Aug 29;24(1):2349. doi: 10.1186/s12889-024-19836-5.
BACKGROUND
Pre-exposure prophylaxis (PrEP) to prevent HIV is severely underutilized among sexually minoritized men (SMM). Inequitable access to PrEP-prescribing facilities and providers is a critical barrier to PrEP uptake among SMM. Integrating HIV prevention services, such as PrEP screening, into pharmacy-based settings is a viable solution to addressing HIV inequities in the US. We aimed to examine willingness to obtain PrEP screening in a pharmacy and its associated correlates, leveraging Andersen's Healthcare Utilization Model (AHUM), among a national sample of SMM in the U.S.
METHODS
Data from the 2020 American Men's Internet Survey, an annual online survey among SMM, were analyzed. Drawing on AHUM-related constructs, we used a modified stepwise Poisson regression with robust variance estimates to examine differences in willingness to screen for PrEP in a pharmacy. Estimated prevalence ratios (PR) were calculated with 95% confidence intervals (CI).
RESULTS
Out of 10,816 men, most (76%) were willing to screen for PrEP in a pharmacy. Participants were more willing to screen for PrEP in a pharmacy if they (1) had a general willingness to use PrEP (PR = 1.52; CI =1.45, 1.59); (2) felt comfortable speaking with pharmacy staff about PrEP (PR = 2.71; CI =2.47, 2.98); and (3) had HIV-related concerns (PR = 1.04; CI =1.02, 1.06). There were no observed differences in men's willingness to screen for PrEP in a pharmacy by race/ethnicity, education level, annual household income, nor insurance status.
CONCLUSIONS
Strategically offering PrEP screening in pharmacies could mitigate access-related barriers to HIV prevention services among SMM, particularly across various sociodemographic domains. Importantly, this approach has vitally important implications for addressing broader inequities in HIV prevention. Future studies should examine strategies to successfully integrate PrEP screenings in pharmacies among diverse populations, especially among those at elevated risk for HIV.
背景
暴露前预防（PrEP）可预防艾滋病毒，但其在性少数男性（SMM）中的使用率极低。获得 PrEP 处方服务和提供者的机会不平等是 SMM 人群接受 PrEP 的一个关键障碍。将艾滋病毒预防服务（如 PrEP 筛查）整合到基于药房的环境中，是解决美国艾滋病毒不平等问题的可行方法。我们旨在利用安德森医疗保健利用模型（AHUM），在美国的 SMM 全国样本中，研究在药房获得 PrEP 筛查的意愿及其相关因素。
方法
分析了 2020 年美国男性互联网调查（一项针对 SMM 的年度在线调查）的数据。借鉴与 AHUM 相关的构建，我们使用修正的逐步泊松回归模型和稳健方差估计来研究在药房中筛查 PrEP 的意愿差异。使用 95%置信区间（CI）计算估计的患病率比（PR）。
结果
在 10816 名男性中，大多数（76%）愿意在药房中筛查 PrEP。如果参与者（1）普遍愿意使用 PrEP（PR=1.52；CI=1.45，1.59）；（2）对与药房工作人员讨论 PrEP 感到舒适（PR=2.71；CI=2.47，2.98）；（3）有艾滋病毒相关问题（PR=1.04；CI=1.02，1.06），则他们更愿意在药房中筛查 PrEP。按种族/民族、教育程度、家庭年收入和保险状况观察，男性在药房中筛查 PrEP 的意愿没有差异。
结论
在药房中战略性地提供 PrEP 筛查可以缓解 SMM 人群获得艾滋病毒预防服务的相关障碍，特别是在各种社会人口统计学领域。重要的是，这种方法对于解决艾滋病毒预防方面的更广泛不平等问题具有至关重要的意义。未来的研究应研究在不同人群中成功整合药房内 PrEP 筛查的策略，特别是在那些艾滋病毒感染风险较高的人群中。
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