Jaiswal Jessica, Grin Benjamin, Gagnon Kelly, John Tejossy, Walters Suzan, Griffin Marybec, Kay Emma
Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, Birmingham, AL, USA.
Subst Use Addctn J. 2025 Jul;46(3):510-517. doi: 10.1177/29767342241288981. Epub 2024 Dec 17.
People who use drugs and patients in substance use treatment may be placed at high risk for HIV due to mixing sex and drugs, potential engagement in sex work, and injection drug use. However, pre-exposure prophylaxis (PrEP) adoption among these populations remains low. Methadone clinics, a main point of contact with the healthcare system for this population, are a missed opportunity to offer biomedical HIV prevention. Understanding provider and staff perceptions of patients' PrEP-related candidacy, acceptability, and adherence is a critical first step to informing PrEP implementation in substance use treatment settings.
Thirty semistructured interviews were conducted at 2 methadone clinics in Northern New Jersey between January and April 2019. Participants included methadone counselors, medical providers, front desk staff, intake coordinators, and other clinic staff members.
Three major themes were identified: (1) provider and staff's perceptions of who would benefit most from PrEP, (2) perceptions of patients' acceptability of PrEP, and (3) perceptions of patients' ability to take a pill every day. Broadly, staff perceived younger patients to be better PrEP candidates than older patients, expressed cautious optimism that PrEP would be acceptable to their patient populations, and were mixed in terms of their perceptions of patients' ability to adhere to PrEP. Notably, staff largely did not mention patients who inject drugs as potential PrEP candidates, suggesting a missed opportunity.
To promote PrEP implementation in methadone clinics, staff and providers should receive training around screening for PrEP eligibility in order to maximize the benefits of PrEP for various subpopulations, especially those who inject. Importantly, discussions around sexual behavior and injection drug use must be approached in an open, non-stigmatizing manner. These findings can be used to inform future interventions to integrate PrEP services into substance use treatment settings.
由于性行为与毒品混用、可能从事性工作以及注射吸毒等原因，吸毒者和接受药物使用治疗的患者感染艾滋病毒的风险可能很高。然而，这些人群中暴露前预防（PrEP）的采用率仍然很低。美沙酮诊所是这一人群与医疗系统的主要接触点，却错失了提供生物医学艾滋病毒预防措施的机会。了解医护人员对患者PrEP相关候选资格、可接受性和依从性的看法，是在药物使用治疗环境中实施PrEP的关键第一步。
2019年1月至4月期间，在新泽西州北部的2家美沙酮诊所进行了30次半结构化访谈。参与者包括美沙酮咨询师、医疗服务提供者、前台工作人员、 intake协调员和其他诊所工作人员。
确定了三个主要主题：（1）医护人员对谁将从PrEP中获益最多的看法；（2）对患者PrEP可接受性的看法；（3）对患者每天服药能力的看法。总体而言，工作人员认为年轻患者比年长患者更适合使用PrEP，对PrEP在其患者群体中会被接受表示谨慎乐观，并且对患者坚持使用PrEP的能力看法不一。值得注意的是，工作人员在很大程度上没有提及注射吸毒患者是潜在的PrEP候选者，这表明错失了一个机会。
为了在美沙酮诊所推广PrEP的实施，工作人员和医疗服务提供者应接受关于PrEP资格筛查的培训，以便使PrEP对各个亚群体，尤其是注射吸毒者的益处最大化。重要的是，围绕性行为和注射吸毒的讨论必须以开放、无歧视的方式进行。这些发现可用于为未来将PrEP服务纳入药物使用治疗环境的干预措施提供参考。 （注：“intake”此处可能是指“接纳患者的流程相关”等意思，因无更多背景难以准确翻译，保留英文）
