Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States.
Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States.
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DOI：
10.1097/qai.0000000000001251
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发表时间：
2017-03-01
期刊：
影响因子：
--
通讯作者：
Grov C
中科院分区：
文献类型：
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作者：
Parsons JT;Rendina HJ;Lassiter JM;Whitfield TH;Starks TJ;Grov C
艾滋病毒护理级联提供了里程碑，以跟踪艾滋病毒阳性患者从血清转化到病毒抑制的进展。基于跨理论的变革模型，我们提出了一个包含五个阶段的动机性PrEP级联。我们分析了995名男性的数据，这是一项对美国hiv阴性的同性恋和双性恋男性进行的纵向研究。几乎所有（89%）的参与者在过去3个月内性活跃，65%的参与者符合CDC的PrEP候选标准。在那些被确定为合适的候选人中，53%的人是预先考虑的（第一阶段；不愿意接受或认为他们是不合适的PrEP候选人），23%的人处于沉思（第二阶段；愿意并自我确定为合适的候选人）。只有11%处于准备阶段（第3阶段；认为PrEP可获得并计划启动PrEP）， 4%处于PrEP行动阶段（第4阶段；处方PrEP）。虽然被确定为合适候选人的人中很少有人服用PrEP，但几乎所有PrEP使用者（98%）报告每周坚持服用4次或更多剂量，大多数人（72%）根据建议每季度进行一次医疗访问，导致9%的PrEP候选人达到维持和坚持（第5阶段）。绝大多数参与者都是PrEP的合适候选人，但只有不到十分之一的人在使用和坚持PrEP。这些研究结果突出表明，需要采取量身定制的干预措施，以解决男性在梯级反应的每个阶段面临的独特障碍，特别是在确定损失最严重的早期阶段。
The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational PrEP Cascade involving five stages based upon the Transtheoretical Model of Change. We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. Nearly all (89%) participants were sexually active in the past 3 months, and 65% met CDC criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (Stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (Stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (Stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (Stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (Stage 5). A large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.