Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in the United States, 2012-2017
Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in the United States, 2012-2017
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DOI：
10.1093/cid/ciaa037
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发表时间：
2021-02-01
影响因子：
11.8
通讯作者：
Hoover, Karen W.
中科院分区：
文献类型：
--
作者：
Huang, Ya-Lin A.;Tao, Guoyu;Hoover, Karen W.
背景每日口服暴露前预防（PrEP）是非常有效的预防人类免疫缺陷病毒（HIV）感染，如果坚持使用整个艾滋病毒的风险时期。我们估计了商业或医疗补助保险人群中的PrEP持续性。我们分析了来自IBM MarketScan研究数据库的数据，以确定在2012年至2017年期间启动PrEP的18-64岁人群。我们通过计算每个人继续填写PrEP处方的时间段来评估PrEP的持久性，直到处方填写的差距> 30天。我们使用Kaplan-Meier时间-事件方法来估计在开始后3个月、6个月和12个月持续使用PrEP的PrEP使用者的比例，并构建考克斯比例风险模型来确定与非持续性相关的患者特征。我们研究了11807名商业保险和647名医疗补助保险人员与PrEP处方。商业保险患者的中位持续时间为13.7个月（95%置信区间[CI]，13.3-14.1），而医疗补助患者为6.8个月（95% CI，6.1-7.6）。此外，女性，年轻的年龄，居住在农村地区，黑人种族与较短的持久性。调整协变量后，我们发现女性（风险比[HR]，1.81 [95%CI，1.56-2.11]）和年轻年龄（18-24岁：HR，2.38 [95%CI，2.11-2.69]）预测非持续性。超过一半的商业保险人谁发起的PrEP坚持了12个月，相比之下，三分之一的医疗补助。更好地了解非持久性的原因对于支持持续使用PrEP和制定针对高危人群不同需求的干预措施非常重要。
Background. Daily oral pre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance.Methods. We analyzed data from the IBM MarketScan Research Database to identify persons aged 18-64 years who initiated PrEP between 2012 and 2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills > 30 days. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after initiation, and constructed Cox proportional hazards models to determine patient characteristics associated with nonpersistence.Results. We studied 11 807 commercially insured and 647 Medicaid insured persons with PrEP prescriptions. Commercially insured patients persisted for a median time of 13.7 months (95% confidence interval [Cl], 13.3-14.1), compared to 6.8 months (95% CI, 6.1-7.6) among Medicaid patients. Additionally, female sex, younger age, residence in rural location, and black race were associated with shorter persistence. After adjusting for covariates, we found that female sex (hazard ratio [ H R], 1.81 [95% CI, 1.56-2.11]) and younger age (18-24 years: HR, 2.38 [95% CI, 2.11-2.69]) predicted nonpersistence.Conclusions. More than half of commercially insured persons who initiated PrEP persisted with it for 12 months, compared to a third of those with Medicaid. A better understanding of reasons for nonpersistence is important to support persistent PrEP use and to develop interventions designed for the diverse needs of at-risk populations.