Demographics, Trends, and Clinical Characteristics of HIV Pre-Exposure Prophylaxis Recipients and People Newly Diagnosed with HIV from Large Electronic Health Records in Florida.
Demographics, Trends, and Clinical Characteristics of HIV Pre-Exposure Prophylaxis Recipients and People Newly Diagnosed with HIV from Large Electronic Health Records in Florida.
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佛罗里达州大型电子健康记录中艾滋病毒暴露前预防接受者和新诊断艾滋病毒患者的人口统计、趋势和临床特征。
DOI：
10.1089/apc.2023.0220
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发表时间：
2024
影响因子：
4.9
通讯作者：
Cook,RobertL
中科院分区：
文献类型：
--
作者：
Liu,Yiyang;Siddiqi,KhairulA;Cho,Hwayoung;Park,Haesuk;Prosperi,Mattia;Cook,RobertL
佛罗里达是艾滋病毒的震中之一，发病率高，社会人口差异明显。我们分析了十年全州范围内的电子健康记录/索赔数据-One佛罗里达+-以识别和描述佛罗里达的暴露前预防（PrEP）接受者和新诊断的HIV病例。应用改进的可计算表型算法，在2013年1月至2021年4月期间，共确定了2186名PrEP接受者和7305名新的艾滋病毒诊断。我们检查了患者的社会人口统计学特征，按自我报告的性别分层，沿着在首次使用PrEP或HIV诊断前12个月内记录的频率驱动和专家选择的临床状况描述。PrEP使用率在两种性别中均有所增加;近年来，随着性别差异的扩大，男性的使用率更高。艾滋病毒感染率在2016年达到峰值，然后下降，观察到的性别差异很小。PrEP和新的艾滋病毒诊断队列之间的临床特征相似，其特征是性传播感染（STI）的患病率较低，精神健康和物质使用状况的患病率较高。研究的局限性包括医疗补助接受者的比例过高，超过96%的女性PrEP使用者接受医疗补助，以及包括那些从事常规医疗保健的人。尽管佛罗里达的PrEP吸收增加，HIV发病率下降，但PrEP接受者之间的性别差异仍然存在。筛查工作超出了有记录的既往性传播感染和高风险行为的个人，特别是女性，包括将精神卫生保健与艾滋病毒咨询和检测相结合，对于进一步平等地获得PrEP和改善艾滋病毒预防计划至关重要。
Florida is one of the HIV epicenters with high incidence and marked sociodemographic disparities. We analyzed a decade of statewide electronic health record/claims data—OneFlorida+—to identify and characterize pre-exposure prophylaxis (PrEP) recipients and newly diagnosed HIV cases in Florida. Refined computable phenotype algorithms were applied and a total of 2186 PrEP recipients and 7305 new HIV diagnoses were identified between January 2013 and April 2021. We examined patients' sociodemographic characteristics, stratified by self-reported sex, along with both frequency-driven and expert-selected descriptions of clinical conditions documented within 12 months before the first PrEP use or HIV diagnosis. PrEP utilization rate increased in both sexes; higher rates were observed among males with sex differences widening in recent years. HIV incidence peaked in 2016 and then decreased with minimal sex differences observed. Clinical characteristics were similar between the PrEP and new HIV diagnosis cohorts, characterized by a low prevalence of sexually transmitted infections (STIs) and a high prevalence of mental health and substance use conditions. Study limitations include the overrepresentation of Medicaid recipients, with over 96% of female PrEP users on Medicaid, and the inclusion of those engaged in regular health care. Although PrEP uptake increased in Florida, and HIV incidence decreased, sex disparity among PrEP recipients remained. Screening efforts beyond individuals with documented prior STI and high-risk behavior, especially for females, including integration of mental health care with HIV counseling and testing, are crucial to further equalize PrEP access and improve HIV prevention programs.