McNulty Moira C, McGuckin Katherine, Friedman Eleanor E, Caputo Matthew, Mason Joseph A, Devlin Samantha A, Giurcanu Mihai, Hazra Aniruddha, Ridgway Jessica P, Achenbach Chad J
Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Ave, MC 5065, Chicago, IL, 60637, USA.
Woebot Health, San Francisco, USA.
AIDS Behav. 2025 Jun 10. doi: 10.1007/s10461-025-04767-y.
Pre-exposure prophylaxis (PrEP) is an effective yet underutilized tool for HIV prevention. We examined opportunities for prescribing PrEP at two large, urban, academic healthcare institutions. We analyzed electronic medical record data for 1/1/2015-12/31/2021 among patients ≥ 18 years of age, with ≥ 1 negative HIV test with indications for PrEP. Eligible encounters were six months after a sexually transmitted infection, or when injection drug use (IDU) was documented. We categorized encounter setting, including the emergency department (ED) and obstetrics and gynecology/women's health (OBGYN) department. We performed logistic mixed effects regression, reporting odds ratios and confidence intervals (OR, aOR, 95% CI). Overall, 9644 people contributed 53,031 encounters with 4653 PrEP prescriptions. The two institutions had different patient population demographics, with institution A having a higher proportion of women, patients aged 18-24, and non-Hispanic Blacks (NHB), and institution B having a higher proportion of men who have sex with men (MSM), non-Hispanic Whites (NHW), and Hispanic/Latinos. Adjusted models found lower odds of PrEP prescriptions for NHB (aOR 0.21 [0.15, 0.29]), Hispanic/Latino (aOR 0.53 [0.37, 0.76]), heterosexual women (aOR 0.10 [0.06, 0.17]), IDU (aOR 0.01 [0.001, 0.08]), and encounters at the ED or OBGYN (0.14 [0.06, 0.31]). Increased odds of PrEP prescription were seen among NHW (aOR 4.85 [3.45, 6.82]), MSM (aOR 24.87 [15.79, 39.15]), and patients at institution B (aOR 1.78 [1.25, 2.53]). Institution A contained people historically underrepresented in PrEP prescriptions, while institution B accounted for most PrEP prescriptions. Opportunities exist to improve equity in PrEP prescriptions among demographic groups and in hospital settings.
暴露前预防（PrEP）是一种有效的艾滋病预防工具，但尚未得到充分利用。我们研究了在两家大型城市学术医疗机构开具PrEP处方的机会。我们分析了2015年1月1日至2021年12月31日期间年龄≥18岁、HIV检测结果为阴性且有PrEP指征的患者的电子病历数据。符合条件的就诊情况为性传播感染后六个月，或有注射吸毒（IDU）记录时。我们对就诊科室进行了分类，包括急诊科（ED）和妇产科/妇女健康科（OBGYN）。我们进行了逻辑混合效应回归分析，报告了比值比和置信区间（OR、aOR、95%CI）。总体而言，9644人有53031次就诊，其中4653次开具了PrEP处方。这两家机构的患者人口统计学特征不同，机构A中女性、18 - 24岁患者和非西班牙裔黑人（NHB）的比例较高，而机构B中男男性行为者（MSM）、非西班牙裔白人（NHW）和西班牙裔/拉丁裔的比例较高。调整后的模型发现，NHB（aOR 0.21 [0.15, 0.29]）、西班牙裔/拉丁裔（aOR 0.53 [0.37, 0.76]）、异性恋女性（aOR 0.10 [0.06, 0.17]）、IDU（aOR 0.01 [0.001, 0.08]）以及在急诊科或妇产科就诊（0.14 [0.06, 0.31]）时开具PrEP处方的几率较低。NHW（aOR 4.85 [3.45,
6.82]）、MSM（aOR 24.87 [15.79, 39.15]）以及机构B的患者（aOR 1.78 [1.25, 2.53]）开具PrEP处方的几率较高。机构A的人群在PrEP处方中历来代表性不足，而机构B开具了大多数PrEP处方。在不同人群组和医院环境中，存在改善PrEP处方公平性的机会。
