Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment.
Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment.
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DOI：
10.1016/j.drugalcdep.2016.12.023
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发表时间：
2017-04-01
影响因子：
4.2
通讯作者：
Copenhaver M
中科院分区：
文献类型：
--
作者：
Shrestha R;Karki P;Altice FL;Huedo-Medina TB;Meyer JP;Madden L;Copenhaver M
虽然使用药物的人（PWUD）是建议接受暴露前预防（PrEP）以预防艾滋病毒的关键人群，但很少有数据可用于指导在这个服务不足的群体中提供PrEP。因此，我们研究了启动PrEP的意愿和对高危PWUD中PrEP降低艾滋病毒风险的预期。在一项对400名参加美沙酮计划并报告近期风险行为的艾滋病毒阴性阿片类药物依赖者的横断面研究中，我们检查了愿意启动PrEP的独立相关因素。虽然只有72人（18%）知道PrEP，但在对其进行描述后，251（62.7%）愿意开始PrEP。这一结果与神经认知功能障碍有关（aOR=3.184，p=0.004）和更高的感知艾滋病毒风险（aOR=8.044，p<0.001）。在那些愿意开始PrEP的人中，分别只有12.5%和28.2%的人表示，他们在PrEP期间总是使用避孕套，而不是共用注射设备。（aOR= 8.315，p =0.016），经常与临时性伴使用安全套（aOR=6.597，p=0.001），并与持续药物注射呈负相关（aOR=0.323，p=0.027）。然而，持续的安全注射与年龄（aOR=0.948，p=0.035），持续的药物注射（aOR=0.342，p<0.001）和感知的HIV风险（aOR=0.191，p=0.019）呈负相关。虽然启动PrEP的意愿很高，并且与艾滋病毒风险升高相关，但即使在PrEP期间，该组中预期的高风险行为也表明下一代艾滋病毒预防方法可能需要将联合收割机生物医学和行为成分结合起来，以维持随着时间的推移降低艾滋病毒风险。
Although people who use drugs (PWUD) are key populations recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP and the anticipation of HIV risk reduction while on PrEP among high-risk PWUD. In a cross-sectional study of 400 HIV-negative, opioid dependent persons enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP. While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. This outcome was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p<0.001). Among those willing to initiate PrEP, only 12.5% and 28.2%, respectively, indicated that they would always use condoms and not share injection equipment while on PrEP. Consistent condom use was associated with higher income (aOR=8.315, p=0.016), always using condoms with casual partners (aOR=6.597, p=0.001), and inversely associated with ongoing drug injection (aOR=0.323, p=0.027). Consistent safe injection, however, was inversely associated with age (aOR=0.948, p=0.035), ongoing drug injection (aOR=0.342, p<0.001), and perceived HIV risk (aOR=0.191, p=0.019). While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to sustain HIV risk reduction over time.