Is Tailoring of PrEP Programs Needed to Overcome Racial Disparities in PrEP Uptake in Local Health Departments? A Mixed-Methods Evaluation of PrEP Implementation in Virginia.
Is Tailoring of PrEP Programs Needed to Overcome Racial Disparities in PrEP Uptake in Local Health Departments? A Mixed-Methods Evaluation of PrEP Implementation in Virginia.
复制标题
是否需要定制 PrEP 计划来克服当地卫生部门在 PrEP 接受方面的种族差异？
DOI：
10.1097/phh.0000000000001463
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Webel,AllisonR
中科院分区：
文献类型：
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作者：
Schexnayder,Julie;Elamin,Fatima;Mayes,Eric;Cox,Lauren;Martin,Elaine;Webel,AllisonR
目的：为了评估艾滋病毒准备实施为非裔美国人和西班牙裔成年人接受医疗护理在弗吉尼亚州的LHDs.Design：我们进行了回顾性的，混合方法的评估准备服务的实施在LHDs完成他们的第一个准备方案之间的一年，2016年6月1日，2019年6月30日。使用药房记录，我们分别使用PrEP需求比（PnR）和药物拥有比（MPR）估计PrEP覆盖率和依从性。专题分析被用来确定障碍PrEP交付6多学科LHD workers.Results采访：433 PrEP客户接受恩曲他滨/替诺福韦二异丙酯富马酸盐（特鲁瓦达）处方在第1年，52.0%自我认定为非洲裔美国人和8.9%自我认定为西班牙裔。在50.0%的诊所中，白色成人的PnR更大。平均MPR（0.79）与保护性药物依从性水平一致;然而，25.0%的客户在计划年仅填写一个处方。定性研究结果表明，非裔美国人和西班牙裔成年人的健康PrEP服务提供和社区偏好之间的不兼容性;然而，在一个健康区域的LHD能够链接社区的颜色PrEP在类似的利率作为Whites.Conclusions：识别一个度量敏感的种族/民族差异的艾滋病毒感染的负担提高认识的PrEP差异;然而，需要人口的具体目标，以加强使用的PnR的程序评估。可能需要为当地PrEP负担最大的社区定制PrEP服务，以优化LHD中PrEP计划的有效性。
Objective:To evaluate HIV PrEP implementation for African American and Hispanic adults receiving medical care in Virginia's LHDs.Design:We conducted a retrospective, mixed-methods evaluation of PrEP services implementation at LHDs completing their first PrEP program year between June 1, 2016, and June 30, 2019. Using pharmacy records, we estimated PrEP coverage and adherence using PrEP to need ratios (PnRs) and medication possession ratios (MPRs), respectively. Thematic analysis was used to identify barriers to PrEP delivery in interviews with 6 multidisciplinary LHD workers.Results:Of the 433 PrEP clients receiving an emtricitabine/tenofovir disoproxil fumarate (Truvada) prescription in year 1, 52.0% self-identified as African American and 8.9% self-identified as Hispanic. PnRs were greater for White adults in 50.0% of clinics. The average MPR (0.79) was consistent with protective medication adherence levels; however, 25.0% of clients filled only one prescription in the program year. Qualitative findings suggest incompatibilities between health PrEP services delivery and community preferences for African American and Hispanic adults; however, LHDs in one health region were able to link communities of color to PrEP at similar rates as Whites.Conclusions:Incorporating a metric sensitive to racial/ethnic differences in the burden of HIV infection improved recognition of PrEP disparities; however, population-specific targets are needed to enhance use of the PnR for program evaluation. Tailoring of PrEP services to communities with the greatest local PrEP burden may be needed to optimize the effectiveness of PrEP programs in LHDs.