Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Division of Prevention Science, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
J Int AIDS Soc. 2024 Oct;27(10):e26362. doi: 10.1002/jia2.26362.
Barriers to pre-exposure prophylaxis (PrEP) access have limited its reach to priority populations. Community-based mobile clinics have potential to broaden PrEP engagement. We evaluated reach and persistence for fixed and mobile clinic cohorts in Miami-Dade County, Florida.
This observational cohort study analysed data from 1896 clients engaged through our fixed or mobile clinic from August 2018 to March 2023. Services were offered at no cost to clients. The same staff and package of barrier-lowering strategies was deployed across fixed and mobile clinic sites. Chi-square and Fisher's exact test or the Kruskal-Wallis test were used to test for differences in characteristics across sites as well as across services sought. Kaplan-Meier curves were generated to evaluate persistence on PrEP and in care, defined as completion of at least one clinic visit (including PrEP prescribing, for PrEP persistence, or for any reason, for persistence in care) within 24 weeks of the prior visit. Cox proportional hazards models were used to evaluate risk factors for discontinuation of PrEP or clinic care by 48 weeks by gender, race, ethnicity, insurance status and site.
The fixed and mobile clinics reached 781 and 1109 clients, respectively, during the study period. The median client age was 35 years; the majority (70.4%) of clients were cisgender men, identified as Hispanic/Latino (62.5%) and were men who have sex with men (54.5%). The mobile clinic extended reach to a higher proportion of cisgender women (32.1% mobile vs. 12.9% for fixed clinic), Black clients (34.5% vs. 13.1%) and older clients (median 37 vs. 33 years) compared with the fixed setting. Uninsured individuals, men and those who initiated services in the mobile clinic were more likely to continue PrEP to 48 weeks (HR: 1.20, p = 0.01; HR: 2.02, p<0.01; HR: 1.68, p<0.01, respectively). Persistence did not differ by race or ethnicity.
A mobile clinic strategy for PrEP engagement can increase reach to key populations underrepresented in HIV prevention care including cisgender women and Black clients. Persistence in PrEP was increased for the mobile clinic cohort, suggesting an additional benefit to this modality beyond other barrier-lowering strategies employed in our fixed and mobile clinics.
暴露前预防（PrEP）获取的障碍限制了其在重点人群中的普及。基于社区的流动诊所具有扩大 PrEP 参与度的潜力。我们评估了佛罗里达州迈阿密-戴德县固定和流动诊所队列的覆盖范围和持久性。
本观察性队列研究分析了 2018 年 8 月至 2023 年 3 月期间通过我们的固定或流动诊所参与的 1896 名客户的数据。向客户提供免费服务。在固定和流动诊所站点部署相同的工作人员和降低障碍的一整套策略。使用卡方检验和 Fisher 确切检验或 Kruskal-Wallis 检验来检验站点之间以及所寻求的服务之间的特征差异。生成 Kaplan-Meier 曲线来评估 PrEP 和护理的持久性，定义为在 24 周内完成至少一次诊所就诊（包括 PrEP 处方，用于 PrEP 持久性，或出于任何原因，用于护理持久性）在前一次就诊之后。使用 Cox 比例风险模型根据性别、种族、民族、保险状况和地点评估 48 周时 PrEP 或诊所护理中断的风险因素。
固定和流动诊所分别在研究期间接待了 781 名和 1109 名客户。客户的中位年龄为 35 岁；大多数（70.4%）客户为跨性别男性，被认定为西班牙裔/拉丁裔（62.5%），且为男男性行为者（54.5%）。流动诊所将服务范围扩大到更多的跨性别女性（32.1%流动诊所 vs. 固定诊所的 12.9%）、黑人和年龄较大的客户（中位数 37 岁 vs. 33 岁）与固定环境相比。与固定诊所相比，未参保者、男性和在流动诊所开始服务的人更有可能在 48 周时继续接受 PrEP（HR：1.20，p=0.01；HR：2.02，p<0.01；HR：1.68，p<0.01）。种族或民族之间的持久性没有差异。
PrEP 参与的流动诊所策略可以增加包括跨性别女性和黑人客户在内的在 HIV 预防护理中代表性不足的重点人群的覆盖面。流动诊所队列的 PrEP 持久性增加，表明该模式除了我们的固定和流动诊所采用的其他降低障碍策略之外，还有额外的益处。
