Understanding Retention in the HIV Pre-Exposure Prophylaxis Cascade Among Cisgender Women.
Understanding Retention in the HIV Pre-Exposure Prophylaxis Cascade Among Cisgender Women.
复制标题
了解顺性别女性中艾滋病毒暴露前预防级联的保留情况。
DOI：
10.1089/apc.2023.0009
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发表时间：
2023
影响因子：
4.9
通讯作者：
Scott,RachelK
中科院分区：
文献类型：
--
作者：
Burns,JamieA;Hull,ShawnikaJ;Inuwa,Aisha;Moriarty,Patricia;Scott,RachelK
艾滋病毒仍然是美国一个重大的公共卫生问题，2019年诊断出34，800例新病例;其中18%为女性。每日口服富马酸替诺福韦酯/恩曲他滨的暴露前预防（PrEP）是有效和安全的，可将女性的艾滋病毒传播降低高达92%。虽然研究表明，口服PrEP的顺性别女性的PrEP依从率较低，但对其中形成PrEP持续的因素知之甚少。这项研究的重点是了解已经启动PrEP的顺性别女性的经验，以深入了解形成PrEP持续的因素。我们进行了半结构化的采访（N= 20）妇女已被规定口服PrEP。采访的指导下，社会生态框架，以确定影响PrEP持续的多层次因素;我们专门研究了参与和保留的经验，在PrEP级联。我们招募了由政府资助的性健康中心或华盛顿的医院计划生育诊所开具口服PrEP的女性。促进PrEP持续的因素包括与PrEP使用相关的积极情绪体验，艾滋病毒感染的高感知风险以及与医疗保健提供者的高质量沟通。PrEP停药的最常见原因是感知的HIV风险低（n= 11）。影响停药的其他因素包括副作用，使用PrEP时的负面情绪体验以及与医疗保健系统的负面互动。这项研究强调了具体的多层次因素的重要性，包括提供旨在与妇女产生共鸣的高质量沟通，以及妇女与其医疗保健提供者之间的共同决策。
HIV remains a significant public health concern in the United States, with 34,800 new cases diagnosed in 2019; of those, 18% were among women. Oral pre-exposure prophylaxis (PrEP) with daily tenofovir disoproxil fumarate/emtricitabine is effective and safe, reducing HIV transmission by up to 92% in women. Though studies demonstrate low rates of PrEP adherence among cisgender women prescribed oral PrEP, little is known about the factors that shape PrEP continuation among them. This study focuses on understanding the experiences of cisgender women who have initiated PrEP to gain insight into the factors that shape PrEP continuation. We conducted semi-structured interviews with (N= 20) women who had been prescribed oral PrEP. Interviews were guided by the social-ecological framework to identify multilevel factors affecting PrEP continuation; we specifically examined the experience of engagement and retention in the PrEP cascade. We recruited women who had been prescribed oral PrEP by a government-sponsored sexual health center or a hospital-based family planning clinic in Washington, DC. Factors facilitating PrEP continuation included a positive emotional experience associated with PrEP use, high perceived risk of HIV acquisition, and high-quality communication with health care providers. The most common reason for PrEP discontinuation was low perceived HIV risk (n= 11). Other factors influencing discontinuation were side effects, a negative emotional experience while using PrEP, and negative interactions with the health care system. This study underscores the importance of specific multi-level factors, including the provision of high-quality communication designed to resonate with women and shared decision making between women and their health care providers.