HIV PrEP is more than ART-lite: Longitudinal study of real-world PrEP services data identifies missing measures meaningful to HIV prevention programming.
HIV PrEP is more than ART-lite: Longitudinal study of real-world PrEP services data identifies missing measures meaningful to HIV prevention programming.
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DOI：
10.1002/jia2.25827
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发表时间：
2021-10
影响因子：
6
通讯作者：
Mohan D
中科院分区：
文献类型：
--
作者：
Reed JB;Shrestha P;Were D;Chakare T;Mutegi J;Wakhutu B;Musau A;Nonyana NM;Christensen A;Patel R;Rodrigues J;Eakle R;Curran K;Mohan D
有证据表明，HIV口服暴露前预防（PrEP）非常有效。许多项目都报告了大量的提前终止率，这可能被误解为项目失败。然而，PrEP的使用可能是不连续的，但仍然有效，因为HIV风险波动。真实的世界PrEP使用现象，如重新开始和周期性使用，以及这些使用模式的时间特征没有得到很好的描述。我们研究的目的是描述和确定在非洲大型PrEP规模扩大计划中观察到的使用模式的预测因素。我们分析了2017年至2019年期间在肯尼亚，莱索托和坦桑尼亚的三个Jhpiego支持项目中定期收集的人口统计和临床数据。我们描述了持续时间开/关PrEP，并使用顺序回归，模拟了花费额外时间的可能性，并确定了与增加周期数相关的因素。Andersen‐Gill模型用于确定PrEP停药时间的预测因素。为了分析与客户在启动后首次返回相关的因素，我们使用了两步Heckman概率单位。在47，532名启动PrEP的客户中，大约一半返回进行随访。随着周期数的每次增加，使用周期之间的PrEP关闭时间减少。Heckman第一步模型显示，老年群体和关键和弱势群体与一般人群相比，返回的概率增加;在第二步模型中，肯尼亚的老年群体和关键和弱势群体不太可能按时返回（补充）而不是延迟返回（重新开始），但在莱索托更有可能。PrEP使用者经常循环使用和停用PrEP。提前停药和延迟获得额外处方很常见，并注意到广泛的预测变异性。在所有国家，停用PrEP的时间随着周期数的增加而减少，这表明使用经验正常化。如果要有意义地衡量PrEP的有效使用，就需要比艾滋病毒治疗更细致入微的使用措施。提供者应配备措施和咨询信息，识别非连续性和周期性的使用模式，以便支持客户调整波动的风险和使用，并在停止后随时重新启动PrEP，实际上使他们能够进一步做出自己的预防选择。
Evidence indicates HIV oral pre‐exposure prophylaxis (PrEP) is highly efficacious and effective. Substantial early discontinuation rates are reported by many programs, which may be misconstrued as program failure. However, PrEP use may be non‐continuous and still effective, since HIV risk fluctuates. Real‐world PrEP use phenomena, like restarting and cyclical use, and the temporal characteristics of these use patterns are not well described. The objective of our study was to characterize and identify predictors of use patterns observed in large PrEP scale‐up programs in Africa. We analysed demographic and clinical data routinely collected during client visits between 2017 and 2019 in three Jhpiego‐supported programs in Kenya, Lesotho and Tanzania. We characterized duration on/off PrEP and, using ordinal regression, modelled the likelihood of spending additional time off and identified factors associated with increasing cycle number. The Andersen‐Gill model was used to identify predictors of time to PrEP discontinuation. To analyse factors associated with a client's first return following initiation, we used a two‐step Heckman probit. Among 47,532 clients initiating PrEP, approximately half returned for follow‐up. With each increase in cycle number, time off PrEP between use cycles decreased. The Heckman first‐step model showed an increased probability of returning versus not by older age groups and among key and vulnerable population groups versus the general population; in the second‐step model older age groups and key and vulnerable populations were less likely in Kenya, but more likely in Lesotho, to return on‐time (refill) versus delayed (restarting). PrEP users frequently cycle on and off PrEP. Early discontinuation and delays in obtaining additional prescriptions were common, with broad predictive variability noted. Time off PrEP decreased with cycle number in all countries, suggesting normalization of use with experience. More nuanced measures of use are needed than exist for HIV treatment if effective use of PrEP is to be meaningfully measured. Providers should be equipped with measures and counselling messages that recognize non‐continuous and cyclical use patterns so that clients are supported to align fluctuating risk and use, and can readily restart PrEP after stopping, in effect empowering them further to make their own prevention choices.
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DOI：
10.1016/s2352-3018(17)30156-x
发表时间：
2018-03
期刊：
The lancet. HIV
影响因子：
--
作者：
Bekker LG;Roux S;Sebastien E;Yola N;Amico KR;Hughes JP;Marzinke MA;Hendrix CW;Anderson PL;Elharrar V;Stirratt M;Rooney JF;Piwowar-Manning E;Eshleman SH;McKinstry L;Li M;Dye BJ;Grant RM;HPTN 067 (ADAPT) study team
通讯作者：
HPTN 067 (ADAPT) study team
在肯尼亚和乌干达的艾滋病毒血清伴侣中预防前预防的示威计划中，遵守性和艾滋病毒获取风险的比对：预防有效依从性的前瞻性分析。
影响因子：
6
作者：
Haberer JE;Kidoguchi L;Heffron R;Mugo N;Bukusi E;Katabira E;Asiimwe S;Thomas KK;Celum C;Baeten JM
通讯作者：
Baeten JM
影响因子：
4.9
作者：
Mugavero, Michael J.;Davila, Jessica A.;Giordano, Thomas P.
通讯作者：
Giordano, Thomas P.
影响因子：
2.5
作者：
Ortblad, Katrina F.;Kearney, John E.;Ngure, Kenneth
通讯作者：
Ngure, Kenneth
DOI：
10.1056/nejmoa1108524
发表时间：
2012-08-02
期刊：
The New England journal of medicine
影响因子：
--
作者：
Baeten JM;Donnell D;Ndase P;Mugo NR;Campbell JD;Wangisi J;Tappero JW;Bukusi EA;Cohen CR;Katabira E;Ronald A;Tumwesigye E;Were E;Fife KH;Kiarie J;Farquhar C;John-Stewart G;Kakia A;Odoyo J;Mucunguzi A;Nakku-Joloba E;Twesigye R;Ngure K;Apaka C;Tamooh H;Gabona F;Mujugira A;Panteleeff D;Thomas KK;Kidoguchi L;Krows M;Revall J;Morrison S;Haugen H;Emmanuel-Ogier M;Ondrejcek L;Coombs RW;Frenkel L;Hendrix C;Bumpus NN;Bangsberg D;Haberer JE;Stevens WS;Lingappa JR;Celum C;Partners PrEP Study Team
通讯作者：
Partners PrEP Study Team