Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study.
Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study.
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DOI：
10.1186/s12889-023-16072-1
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发表时间：
2023-06-13
影响因子：
4.5
通讯作者：
中科院分区：
文献类型：
--
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密西西比州是美国艾滋病毒感染率最高的州之一，但PrEP的吸收率很低。了解PrEP的使用模式可以改善PrEP的启动和持续性。这是对密西西比杰克逊的PrEP计划的混合方法评估。在2018年11月至2019年12月期间，参加非临床检测中心的艾滋病毒高风险客户被转介给药剂师进行当天的PrEP启动。药剂师提供了90天的PrEP处方，并在三个月内安排了后续临床预约。我们将这次访问的客户记录与杰克逊两个最大的PrEP诊所的电子健康记录联系起来，以确定与正在进行的临床护理的联系。我们确定了四种不同的PrEP使用模式，我们将其用于定性访谈抽样：1）在三个月内填写处方并链接到护理; 2）在三个月后填写处方并链接到护理; 3）填写处方但从未链接到护理;以及4）从未填写处方。在2021年，我们有目的地对这四组患者进行了抽样调查，以确定PrEP启动和持续的障碍和促进因素，使用计划行为理论提供的指南。有121名客户接受了PrEP评估;所有人都得到了处方。三分之一的人不到25岁，77%是黑人，59%是与男性发生性关系的顺性别男性。四分之一（26%）的人从未填写过他们的PrEP处方，44%的人拿起处方但从未与临床护理联系在一起，12%的人在三个月后的某个时候与护理联系在一起（导致PrEP覆盖率的差距），18%的人在3个月内与护理联系在一起。我们采访了121位客户中的26位。定性数据显示，成本，与性和艾滋病毒相关的耻辱，有关PrEP的错误信息，以及感知的副作用是吸收和持久性的障碍。个人保持健康的愿望和PrEP诊所工作人员的支持是促进因素。大多数人给予同一天的PrEP处方要么从未开始PrEP或在前三个月内停止PrEP。解决所指出的耻辱和错误信息的障碍，减少结构性障碍，可能会增加PrEP的启动和持久性。 在线版本包含补充材料，可通过10.1186/s12889-023-16072-1获得。
Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence. This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior. There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals’ desire to stay healthy and the support of PrEP clinic staff were facilitators. The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence. The online version contains supplementary material available at 10.1186/s12889-023-16072-1.
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DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
AJZEN, I
影响因子：
5.5
作者：
Bonacci RA;Smith DK;Ojikutu BO
通讯作者：
Ojikutu BO
DOI：
10.1007/s40615-022-01278-7
发表时间：
2022-03-15
影响因子：
3.9
作者：
Ayangeakaa, Suur D.;Kerr, Jelani;Sterrett-Hong, Emma
通讯作者：
Sterrett-Hong, Emma
DOI：
10.1097/qai.0000000000001724
发表时间：
2018-09-01
影响因子：
3.6
作者：
Doblecki-Lewis, Susanne;Liu, Albert Y.;Kolber, Michael A.
通讯作者：
Kolber, Michael A.
影响因子：
11.8
作者：
Liu, Albert Y.;Vittinghoff, Eric;Fuchs, Jonathan D.
通讯作者：
Fuchs, Jonathan D.