Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men
Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men
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DOI：
10.1089/apc.2017.0171
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发表时间：
2017-11-01
影响因子：
4.9
通讯作者：
Mayer, Kenneth H.
中科院分区：
文献类型：
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作者：
Marks, Sarah J.;Merchant, Roland C.;Mayer, Kenneth H.
在美国，男男性行为者（YMSM）仍然是艾滋病毒感染率最高的人群之一。暴露前预防（PrEP）是预防艾滋病毒感染的有效和安全的方法;然而，尽管美国食品和药物管理局批准，利用率仍然很低，部分原因是结构性障碍，特别是获得医疗保健。在这项研究中，我们使用社交媒体招募了18至24岁的黑人，西班牙裔和白色未感染艾滋病毒的YMSM。参与者完成了一项关于他们的性行为，医疗保健服务和以前使用PrEP的在线调查。在接受调查的2297名YMSM中，只有3.4%使用过PrEP。PrEP的使用与较高的教育水平，独居，年龄较大，性活动水平较高以及医疗保健服务更多有关，特别是有医疗保险和诊所或初级保健提供者（PCP），他们从他们那里得到照顾。在PrEP非使用者中，65%的人至少符合美国疾病控制和预防中心推荐的PrEP使用适应症之一，其中59%有医疗保险，并在诊所接受护理和/或有PCP。多变量多项逻辑回归模型确定了年龄、种族/民族、教育和地区在获得医疗保健方面的差异。具体来说，老年YMSM，黑人和西班牙裔，那些受正规教育年限较少的人，以及美国南部和西部的居民更有可能缺乏医疗保健。这些结果表明，YMSM中扩大PrEP的潜在机会和障碍。
Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM.