Examination of HIV Preexposure Prophylaxis Need, Availability, and Potential Pharmacy Integration in the Southeastern US.
Examination of HIV Preexposure Prophylaxis Need, Availability, and Potential Pharmacy Integration in the Southeastern US.
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DOI：
10.1001/jamanetworkopen.2023.26028
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发表时间：
2023-07-03
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
--
作者：
在美国东南部，药店在帮助扩大暴露前预防（PrEP）服务方面的潜在影响是什么？在这项对美国东南部6个州的横断面研究中，与目前的PrEP处方地点相比，药店有更大的能力满足美国东南部居民对PrEP的需求。将PrEP处方扩大到药店的最大受益州包括肯塔基州、南卡罗来纳州和田纳西州。这些研究结果表明，如果服务扩展到美国东南部的药店，艾滋病预防和护理服务将大幅增加。这项横断面研究评估了美国东南部社区目前的艾滋病毒负担，这些社区目前有暴露前预防（PrEP）处方地点和药店，并计算了地点与需求的比率。每日暴露前预防（PrEP）的使用可以预防高达99%的艾滋病毒感染;然而，由于艾滋病毒风险增加的人群难以获得PrEP处方地点，特别是在美国东南部，PrEP的摄入量很低。药房是增加PrEP获取的可行选择，但关于它们如何补充当前的PrEP处方地点知之甚少。根据东南部的艾滋病毒风险，检查当前PrEP处方地点与药店和设施需求比（PFNRs）的地理分布，并描述药店扩大PrEP获取的潜在范围。这项关于PrEP处方地点和药店的横断面研究的数据是从2021年1月1日至12月31日汇编的。本研究中包括的东南部州或特定县是被确定为结束美国艾滋病毒流行（EHE）倡议的高优先领域的司法管辖区。将艾滋病毒预防服务扩大到药店。在美国东南部的EHE管辖区，每10万人的5年HIV风险的Choropleth地图。PrEP处方地点（从PrEP处方者的国家数据库中获得）和药房（从州药房委员会获得）覆盖在HIV风险地图上。各州的PFNR计算为设施数量（PrEP处方地点或药房）除以每10万人的5年艾滋病毒风险。较低的PFNR表明满足艾滋病毒高危人群需求的地点的地理可用性较低。比较了当前PrEP处方地点与药店的PFNR。在东南部的2个州和东南部4个州的13个县中，PrEP处方地点在EHE地区分布不均匀，艾滋病毒高风险地区的分布明显较少。药房均匀地分布在各个地区，无论艾滋病毒风险如何。目前PrEP处方地点的所有州的平均PFNR为0.008（中位数为0.000 [IQR，0.000-0.003]）;对于药店，为0.7（中位数为0.3 [IQR，0.01-0.1]）。与PrEP处方地点相比，药店的PFNR至少高出20.3倍。随着药品的扩展，PFNR增加潜力最大的州包括肯塔基州、南卡罗来纳州和田纳西州。这项横断面研究的结果表明，将艾滋病毒预防服务扩大到东南部EHE地区的药店可以显着提高接触艾滋病毒传播风险增加的个人的能力。旨在允许药剂师开PrEP处方并提供艾滋病毒预防服务的立法可能是结束艾滋病毒流行的重要下一步。
What is the potential reach of pharmacies in helping to expand preexposure prophylaxis (PrEP) access across the southeastern US? In this cross-sectional study of 6 states in the southeastern US, pharmacies had greater ability to meet the need for PrEP among residents of the southeastern US compared with current PrEP-prescribing locations. States that could see the greatest benefit from expansion of PrEP prescribing to pharmacies included Kentucky, South Carolina, and Tennessee. These findings suggest a substantial potential increase in HIV prevention and care services if services were expanded to pharmacies across the southeastern US. This cross-sectional study evaluates the current burden of HIV in communities across the southeastern US with current preexposure prophylaxis (PrEP)-prescribing locations and pharmacies and calculates the ratio of location to need. Daily preexposure prophylaxis (PrEP) use can prevent up to 99% of HIV infections; however, PrEP uptake is low due to poor access to PrEP-prescribing locations for populations at increased risk for HIV, especially in the southeastern US. Pharmacies are a feasible option to increase PrEP access, but little is known about how they could complement current PrEP-prescribing locations. To examine geographic distributions of current PrEP-prescribing locations compared with pharmacies and the facility to need ratios (PFNRs) according to HIV risk in the Southeast and describe the potential reach of pharmacies to expand PrEP access. Data for this cross-sectional study of PrEP-prescribing locations and pharmacies were compiled from January 1 to December 31, 2021. States or specific counties in the Southeast included in this study were jurisdictions identified as high-priority areas for the Ending the HIV Epidemic in the US (EHE) initiative. Expansion of HIV prevention services to pharmacies. Choropleth maps of 5-year HIV risk per 100 000 persons were developed for EHE jurisdictions in the southeastern US. PrEP-prescribing locations (obtained from a national database of PrEP prescribers) and pharmacies (obtained from state pharmacy boards) were overlayed on HIV risk maps. The PFNRs by state were calculated as number of facilities (PrEP-prescribing locations or pharmacies) divided by 5-year HIV risk per 100 000 persons. Lower PFNRs indicated lower geographic availability of locations to meet the needs of the population at risk for HIV. The PFNRs for current PrEP-prescribing locations vs pharmacies were compared. Among the 2 southeastern states and 13 counties in 4 southeastern states included, PrEP-prescribing locations were unequally distributed across EHE areas, with substantially fewer in areas at high risk for HIV. Pharmacies were evenly dispersed across areas regardless of HIV risk. The mean PFNR across all states for current PrEP-prescribing locations was 0.008 (median, 0.000 [IQR, 0.000-0.003]); for pharmacies, it was 0.7 (median, 0.3 [IQR, 0.01-0.1]). The PFNRs were at least 20.3 times higher for pharmacies compared with PrEP-prescribing locations. States with the greatest potential increase in PFNRs with expansion to pharmacies included Kentucky, South Carolina, and Tennessee. The findings of this cross-sectional study suggest that expanding HIV prevention services to pharmacies in EHE areas in the Southeast could significantly increase capacity to reach individuals at increased risk of HIV transmission. Legislation aimed at allowing pharmacists to prescribe PrEP and provide HIV prevention services may be an important next step in ending the HIV epidemic.
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影响因子：
2.9
作者：
Adams, Alex J.;Weaver, Krystalyn K.
通讯作者：
Weaver, Krystalyn K.
影响因子：
4.4
作者：
Rao S;Reed AE;Parchem B;Edelman EJ;Magnus M;Hansen NB;Kershaw TS;Earnshaw VA;Krakower DS;Dovidio JF;Mayer KH;Underhill K;Rosenberger JG;Ogburn DF;Betancourt JR;Calabrese SK
通讯作者：
Calabrese SK
影响因子：
1.7
作者：
Crawford ND;Harrington KRV;Alohan DI;Sullivan PS;Holland DP;Klepser DG;Quamina A;Siegler AJ;Young HN
通讯作者：
Young HN
影响因子：
3.7
作者：
Leech, Ashley A.;Christiansen, Cindy L.;Drainoni, Mari-Lynn
通讯作者：
Drainoni, Mari-Lynn
影响因子：
12.7
作者：
Siegler, Aaron J.;Bratcher, Anna;Weiss, Kevin M.
通讯作者：
Weiss, Kevin M.