Preexposure Prophylaxis Outcomes in an Urban Community in North Carolina: Discontinuation of Care and Sexually Transmitted Infections.
Preexposure Prophylaxis Outcomes in an Urban Community in North Carolina: Discontinuation of Care and Sexually Transmitted Infections.
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DOI：
10.1097/olq.0000000000001288
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发表时间：
2021-03-01
影响因子：
3.1
通讯作者：
McKellar M
中科院分区：
文献类型：
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作者：
Clement ME;Nicchitta M;Sun Y;Ellis A;Chakraborty H;McGee K;Eagle C;Frye J;Taylor D;Okeke NL;Johnston B;Seña AC;McKellar M
很少有研究考察南方开始暴露前预防 (PrEP) 的人的长期结果，包括 PrEP 终止和性传播感染 (STI) 率。在北卡罗来纳州达勒姆的两家 PrEP 诊所对患者的护理中断（> 6 个月未进行 PrEP 预约）和性传播感染事件进行了评估。我们使用逻辑回归将停药的预测因子作为二元变量进行测试。模型协变量包括年龄、种族/民族、性别、已知的 HIV 阳性伴侣、商业性工作、男男性行为者 [MSM] 与非 MSM、保险类型和诊所地点。对性传播感染的发病率进行了类似的分析，并控制了研究中的天数。 271 名患者中，平均年龄为 33.2 岁，其中 46.9% 为黑人，11.1% 为拉丁裔； 81.2% 是 MSM，32% 没有保险。 47% 的人停止了 PrEP，另外 11% 的人接受间歇性护理。 STI 发病率为 45.4/100 人年，有 5 名患者在基线或随访中被诊断出感染 HIV。相对于非 MSM，MSM 停止 PrEP 的可能性较小 (OR=0.26 (95%CI=0.10-0.64)。基线 STI 与发生 STI 的较高可能性相关 (OR=8.19；95% CI= 3.69-19.21)，而停止护理与 STI 的较低可能性相关 (OR=0.28，CI 0.11-0.65)。美国南部的计划覆盖到没有保险的人群，主要是黑人和拉丁裔男男性行为者，但尽管性传播感染和艾滋病毒的发病率较高，但仍需要进一步开展工作来阐明停止使用 PrEP 的原因并鼓励坚持护理。一项针对北卡罗来纳州 PrEP 使用者的研究发现，计划覆盖到少数族裔患者的比例很高，但终止率很高，而性传播感染的发生率中等。
Few studies have examined long-term outcomes among persons who initiate pre-exposure prophylaxis (PrEP) in the South, including PrEP discontinuation and sexually transmitted infection (STI) rates. Care discontinuation (>6 months without a PrEP appointment) and incident STIs were evaluated for patients at two PrEP clinics in Durham, North Carolina. We tested for predictors of discontinuation as a binary variable using logistic regression. Model covariates included age, race/ethnicity, sex, known HIV-positive partner, commercial sex work, men who have sex with men [MSM] vs not MSM, type of insurance and clinic site. A similar analysis was completed for STI incidence, controlling for days in the study. Among 271 patients, mean age was 33.2, 46.9% were Black and 11.1% were Latino; 81.2% were MSM, and 32% were uninsured. PrEP was discontinued in 47%, and another 11% had intermittent care. STI incidence was 45.4/100 person years and five patients were diagnosed with HIV at baseline or in follow-up. MSM were less likely to discontinue PrEP relative to non-MSM (OR=0.26 (95%CI=0.10-0.64). Baseline STI was associated with a higher likelihood of incident STI (OR=8.19; 95% CI= 3.69-19.21), while care discontinuation was associated with a lower likelihood of STI (OR=0.28, CI 0.11-0.65). PrEP programs in the Southern US are reaching uninsured and predominantly Black and Latino MSM, but discontinuation rates are high despite elevated rates of incident STI and HIV. Further work is required to elucidate causes of PrEP discontinuation and encourage persistence in care. A study of PrEP users in North Carolina found programs were reaching high rates of racial/ethnic minority patients. However, rates of discontinuation were high and rates of STIs were moderate.