Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016-2020.
Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016-2020.
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DOI：
10.1371/journal.pone.0265434
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Schwartz S
中科院分区：
文献类型：
--
作者：
Rao A;Mhlophe H;Comins C;Young K;Mcingana M;Lesko C;Mulumba N;Baral S;Hausler H;Schwartz S
尽管PrEP在预防艾滋病毒方面的有效性已经确立，而且用户控制的方法具有优势，但妇女在试验和示范项目中对PrEP的吸收和持久性一直不是最理想的。我们使用了来自HIV服务提供商的真实世界数据来描述南非eThekwini的女性性工作者(FSW)对口服PrEP的持久性。我们研究了2016-2020年间在eThekwini结核病艾滋病毒护理中心启动PrEP的所有FSW从启动PrEP到停止的时间。我们使用了离散的事件发生时间数据设置和堆叠的累积关联函数图，显示了1)未返回PrEP、2)客户中断和3)提供商中断的竞争风险。我们使用互补对数-对数回归计算风险比，使用竞争风险回归计算子风险比。发起数量从2016年的155件(9.3%，n=155/1659)增加到2020年的1224件(27.5%，n=1224/4446)。开始后1个月的持续率为53%(95%可信区间：51%~55%)。与25岁及以上的女性相比，年轻女性更有可能通过不回来而停止PrEP。对于那些在以后几年开始的人来说，由于不返还而中断的风险降低了。尽管发生了新冠肺炎大流行，但在2020年观察到了更多的倡议和持续的坚持。观察到低水平的PrEP持久性，这与其他地方未得到充分服务的妇女的数据一致。令人鼓舞的是，坚持下去的妇女比例随着时间的推移而增加，即使新发起初级保健方案的妇女人数和工作人员工作量也增加了。需要进一步的研究来了解该计划可能已经制定了哪些实施战略来促进这些改进，以及可能需要进行哪些进一步的改变。
Despite the established efficacy of PrEP to prevent HIV and the advantages of a user-controlled method, PrEP uptake and persistence by women in both trials and demonstration projects has been suboptimal. We utilized real-world data from an HIV service provider to describe persistence on oral PrEP among female sex workers (FSW) in eThekwini, South Africa. We examined time from PrEP initiation to discontinuation among all FSW initiating PrEP at TB HIV Care in eThekwini between 2016–2020. We used a discrete time-to-event data setup and stacked cumulative incidence function plots, displaying the competing risks of 1) not returning for PrEP, 2) client discontinuation, and 3) provider discontinuation. We calculated hazard ratios using complementary log-log regression and sub-hazard ratios using competing risks regression. The number of initiations increased each year from 155 (9.3%, n = 155/1659) in 2016 to 1224 (27.5%, n = 1224/4446) in 2020. Persistence 1-month after initiation was 53% (95% CI: 51%-55%). Younger women were more likely to discontinue PrEP by not returning compared with those 25 years and older. Risk of discontinuation through non-return declined for those initiating in later years. Despite the COVID-19 pandemic, a greater number of initiations and sustained persistence were observed in 2020. Low levels of PrEP persistence were observed, consistent with data among underserved women elsewhere. Encouragingly, the proportion of women persisting increased over time, even as the number of women newly initiating PrEP and staff workload increased. Further research is needed to understand which implementation strategies the program may have enacted to facilitate these improvements and what further changes may be necessary.
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影响因子：
56.3
作者：
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通讯作者：
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DOI：
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