Reaching Those Most at Risk for HIV Acquisition: Evaluating Racial/Ethnic Disparities in the Preexposure Prophylaxis Care Continuum in Baltimore City, Maryland.
Reaching Those Most at Risk for HIV Acquisition: Evaluating Racial/Ethnic Disparities in the Preexposure Prophylaxis Care Continuum in Baltimore City, Maryland.
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DOI：
10.1097/qai.0000000000002712
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发表时间：
2021-08-15
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减少艾滋病毒发病率需要解决艾滋病毒负担中持续存在的种族/族裔差异问题。我们的目标是在马里兰州巴尔的摩市参与卫生部门领导的增加暴露前预防(PrEP)示范项目的七个临床站点中，评估暴露前预防(PrEP)交付的总体和相对于社区需求。准备护理-在2015年9月30日至2019年9月29日期间，对在参与地点接受服务的艾滋病毒阴性个人进行了连续阶段(筛查、指示、转诊、联系、评估、处方)的检查。使用关于艾滋病毒新诊断的信息来定义社区需求(2016-2018年)。分别使用改进的泊松回归和卡方检验来检验不同人口统计学/优先人群的护理连续进展的差异，以及护理连续阶段和新诊断艾滋病毒患者之间的人口构成比较。在25,886名接受PrEP筛查的人中，大多数是非西班牙裔黑人(81.1%，n=20,998)，顺性别男性(61.1%，n=15,825)和异性恋(86.7%，n=22,452)。共有31.1%(n=8,063)的患者指示使用PrEP，其中56.8%(n=4,578)、15.6%(n=1,250)、10.8%(n=868)和9.0%(n=722)分别被推荐、联系、评估和处方。在2870名男男性接触者中，18.7%(n=538)使用了PrEP。在所有组中，PrEP相关和PrEP相关之间的消耗率最高。NH黑人种族(与NH白人)独立地与PrEP处方的较低可能性相关[APR：0.89；95%CI：(0.81-0.98)控制年龄/性别]。相对于新诊断的HIV患者的人口构成，使用PrEP处方的NH黑人(80.2%比54.3%)和更多的NH白人(10.7%比30.3%)和MSM(55.2%比74.5%)更少。这个项目显示了向男男性接触者提供PrEP转诊和处方的前景。需要实质性的改进，以改善整体联系，并减少NH-黑人中PrEP处方的差异。今后的工作应侧重于解决阻碍PrEP利用的服务差距。
Reducing HIV incidence requires addressing persistent racial/ethnic disparities in HIV burden. Our goal was to evaluate pre-exposure prophylaxis (PrEP) delivery, overall and relative to community need, among seven clinical sites participating in a health-department led demonstration project to increase PrEP in Baltimore City, Maryland. PrEP care-continuum stages (screened, indicated, referred, linked, evaluated, prescribed) were examined among HIV-negative individuals receiving services at participating sites between September 30, 2015–September 29, 2019. Community need was defined using information on new HIV diagnoses (2016–2018). Differences in care-continuum progression by demographics/priority population, and comparison of demographic compositions between care-continuum stages and new HIV-diagnoses were examined using modified Poisson regression and Chi-squared tests, respectively. Among 25,886 PrEP-screened individuals, the majority were non-Hispanic(NH) Black(81.1%, n=20,998), cisgender-male(61.1%, n=15,825) and heterosexual(86.7%, n=22,452). Overall, 31.1%(n=8,063) were PrEP-indicated, among whom, 56.8%(n=4,578), 15.6%(n=1,250), 10.8%(n=868), and 9.0%(n=722) were PrEP-referred, linked, evaluated and prescribed, respectively. Among 2,870 MSM, 18.7%(n=538) were PrEP-prescribed. Across all groups, the highest attrition was between PrEP-referred and PrEP-linked. NH-Black race (vs. NH-white) was independently associated with lower likelihood of PrEP-prescription [aPR: 0.89; 95% CI:(0.81–0.98) controlling for age/gender]. Relative to the demographic composition of new HIV-diagnoses, fewer NH-Blacks (80.2% vs. 54.3%) and more NH-whites (10.7% vs. 30.3%) and MSM were PrEP-prescribed (55.2% vs. 74.5%). This project showed promise delivering PrEP referrals and prescriptions overall and to MSM. Substantial improvement is needed to improve linkage overall and to decrease disparities in PrEP-prescriptions among NH-Blacks. Future work should focus on addressing service gaps that hinder PrEP utilization.