Suboptimal Uptake, Retention, and Adherence of Daily Oral Prexposure Prophylaxis Among People With Opioid Use Disorder Receiving Hepatitis C Virus Treatment.
Suboptimal Uptake, Retention, and Adherence of Daily Oral Prexposure Prophylaxis Among People With Opioid Use Disorder Receiving Hepatitis C Virus Treatment.
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DOI：
10.1093/ofid/ofab658
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发表时间：
2022-03
影响因子：
4.2
通讯作者：
Rosenthal E
中科院分区：
文献类型：
--
作者：
Brokus C;Kattakuzhy S;Gayle B;Narayanan S;Davis A;Cover A;Eyasu R;Ebah E;Ogbumbadiugha-Weekes O;Hoffmann J;Silk R;Stevens J;Mount J;Gannon C;Nussdorf L;Mathur P;Bijole P;Jones M;Kier R;Sternberg D;Greenblatt A;Weintraub E;Masur H;Kottilil S;Rosenthal E
每日口服富马酸替诺福韦二吡呋酯 (TDF)/恩曲他滨 (FTC) 口服暴露前预防 (PrEP) 可预防注射吸毒者 (PWID) 中的人体免疫缺陷 (HIV)。尽管艾滋病毒发病率和注射吸毒 (IDU) 不断上升，但 PrEP 的使用率仍然很低，而且关于注射吸毒者的吸收、依从性和保留率的研究有限。 ANCHOR 调查评估了华盛顿特区和马里兰州巴尔的摩个人的基于社区的护理模式，该模式结合了丙型肝炎病毒 (HCV) 治疗、阿片类药物使用障碍 (OUD) 药物和 PrEP。 PrEP 咨询从 HCV 治疗第 0 天到第 24 周进行。受试者可以在此窗口期间的任何时间开始，随访 48 周，并通过自我报告和干血斑 TDF 分析评估依从性。共有 198 名参与者参加，其中 185 名 (93%) 艾滋病毒呈阴性。 29 人（HIV 阴性人群的 15.7%）开始了 PrEP。 116 名参与者 (62.7%) 因 IDU (82 [44.3%])、性别 (9 [4.9%]) 或两者兼有 (25 [13.5%]) 符合 2014 年疾病控制与预防中心 (CDC) PrEP 标准。提供者向 94 人 (50.8%) 推荐了 PrEP，并且推荐与 PrEP 的采用率相关。中位治疗持续时间为 104 天（四分位数范围，28-276 天），其中 8 名参与者保留到第 48 周。根据自我报告，依从性随时间变化，并根据 TDF 分析下降。没有发生 HIV 血清转化。尽管大多数 HCV 和 OUD 患者均符合 CDC 标准，但 PrEP 的使用率较低。高中断率和中止率，再加上依从性的差异，使得 TDF/FTC 成为次优的预防策略。长效制剂等新兴模式可能会解决这些障碍，但迄今为止，吸毒者已被排除在其开发之外。尽管大多数患有丙型肝炎和阿片类药物使用障碍的人都符合疾病预防控制中心的标准，但暴露前预防的采用率较低。高中断率和停药率，再加上依从性的差异，使得富马酸替诺福韦二吡呋酯/恩曲他滨成为次优的预防策略。
Daily oral preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevents human immunodeficiency (HIV) among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use (IDU), PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID. The ANCHOR investigation evaluated a community-based care model collocating hepatitis C virus (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC, and Baltimore, Maryland. PrEP counseling was conducted from HCV treatment day 0 until week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried blood spot TDF analysis. One hundred ninety-eight participants were enrolled, of whom 185 (93%) were HIV negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. One hundred sixteen participants (62.7%) met 2014 Centers for Disease Control and Prevention (CDC) PrEP criteria due to IDU (82 [44.3%]), sex (9 [4.9%]), or both practices (25 [13.5%]). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (interquartile range, 28–276 days), with 8 participants retained through week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date. People with hepatitis C and opioid use disorder experienced low uptake of preexposure prophylaxis despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made tenofovir disoproxil fumarate/emtricitabine a suboptimal prevention strategy.
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