Patterns and Correlates of Participant Retention in a Multi-City Pre-Exposure Prophylaxis Demonstration Project
Patterns and Correlates of Participant Retention in a Multi-City Pre-Exposure Prophylaxis Demonstration Project
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DOI：
10.1097/qai.0000000000001724
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发表时间：
2018-09-01
影响因子：
3.6
通讯作者：
Kolber, Michael A.
中科院分区：
文献类型：
--
作者：
Doblecki-Lewis, Susanne;Liu, Albert Y.;Kolber, Michael A.
背景资料：暴露前预防（PrEP）的安全有效使用取决于最初参与后护理中的保留。设置：美国PrEP示范项目为旧金山弗朗西斯科、迈阿密和华盛顿，华盛顿特区的参与者提供每日口服替诺福韦/恩曲他滨，从2012年至2014年持续48周。研究前12周内的早期失访（ELTF）、整个研究期间的保留或间歇性保留，其中错过或延迟访视导致药物可用性缺口。对每组的基线特征进行制表。结果：总体而言，366/554（66.1%）的登记参与者保留了所有研究访视，127/554（22.9%）有间歇性保留，61/554（11.0%）ELTF。在多变量分析中，迈阿密与旧金山弗朗西斯科研究中心相比，与ELTF而非完全保留相关[aOR 2.84;置信区间（CI）：1.24至6.47]，也与间歇性而非完全保留相关（aOR 2.70; CI：1.43至5.11）。与完全保留相比，年龄较小与ELTF（年龄每减少10岁aOR 1.80; CI：1.26至2.57）和间歇性保留（aOR 1.47; CI：1.17至1.84）相关。ELTF相关因素（但不是间歇性保留）与完全保留相比，黑人与白色相比aOR 3.32; CI：1.09至10.16），报告性工作（aOR 4.67; CI：1.49至14.58），缺乏正规就业（aOR 2.53; CI：1.27至5.05），以及缺乏以前的PrEP意识（aOR 2.01; CI：1.01至3.96）.结论：针对PrEP护理损失的原因和风险因素的量身定制的干预措施可能会改善PrEP使用的保留和一致性。
Background: Safe and effective use of pre-exposure prophylaxis (PrEP) depends on retention in care after initial engagement.Setting: The United States PrEP Demonstration Project offered daily oral tenofovir/emtricitabine to participants in San Francisco, Miami, and Washington, D.C. for 48 weeks from 2012 to 2014.Methods: The Demo Project participants' patterns of retention were assigned to 1 of 3 categories: early loss to follow-up (ELTF) within the first 12 weeks of the study, retention throughout the study, or intermittent retention in which missed or delayed visits resulted in gaps in medication availability. For each group, baseline characteristics were tabulated. A two-step multivariable analysis was performed.Results: Overall, 366/554 (66.1%) of enrolled participants were retained for all study visits, 127/554 (22.9%) had intermittent retention, and 61/554 (11.0%) ELTF. In multivariable analysis, Miami compared with San Francisco site was associated with ELTF rather than full retention [aOR 2.84; confidence interval (CI): 1.24 to 6.47] and also with intermittent rather than full retention (aOR 2.70; CI: 1.43 to 5.11). Younger age was associated with ELTF (aOR 1.80 for each 10-year decrement in age; CI: 1.26 to 2.57) and intermittent retention (aOR 1.47; CI: 1.17 to 1.84) compared with full retention. Factors associated with ELTF (but not intermittent retention) compared with full retention were black compared with white aOR 3.32; CI: 1.09 to 10.16), reporting sex work (aOR 4.67; CI: 1.49 to 14.58), lack of regular employment (aOR 2.53; CI: 1.27 to 5.05), and lack of previous PrEP awareness (aOR 2.01; CI: 1.01 to 3.96).Conclusions: Tailored interventions addressing causes and risk factors for loss from PrEP care may improve retention and consistency of PrEP use.