Gaps and Determinants in PrEP Uptake and Need: Understanding Disparities in PrEP Among Women in the United States

摘要 2020年，女性占美国艾滋病新诊断病例的18%，但仅占艾滋病前诊断病例的7.4%。 暴露预防（PrEP）使用者。此外，2020年被诊断感染艾滋病毒的妇女中有71%是 黑人/非裔美国人或西班牙裔。PrEP已被证明可以减少艾滋病毒感染事件， 向美国卫生与公众服务部提供大量公共卫生机会 宣布了终止艾滋病毒流行的倡议。然而，艾滋病毒感染风险的一个重要组成部分， 女性与其男性性伴侣的行为有关，而伴侣的这些风险可能是未知的， 妇女此外，用于记录PrEP用户的关键数据集中种族/民族数据的完整性 在美国，这是有限的，导致我们的估计偏差。建议的分析将（1）确定特征 基于其伴侣关系的妇女，这些伴侣关系是PrEP的指征，特别是那些未被承认的指征 由女性及其医疗保健提供者，2）使用多重插补来完成目前的人种/种族数据 药物使用数据集，以更好地了解女性PrEP使用者的当前种族/民族分布， 和3）分析美国妇女中PrEP摄取的时空模式。综合起来看， 该提案的目标是促进我们对需要PrEP的人，种族/民族的理解 目前正在使用PrEP的分布，考虑到风险因素， 艾滋病病毒感染。

ABSTRACT Women accounted for 18% of new HIV diagnoses in the United States in 2020 and yet only 7.4% of the pre- exposure prophylaxis (PrEP) users. Additionally, 71% of the women diagnosed with HIV in 2020 were Black/African American or Hispanic. PrEP has been shown to reduce incident HIV infection, providing a substantial public health opportunity to work towards the US Department of Health and Human Services announced the Ending the HIV Epidemic initiative. However, a substantial component of risk of HIV infection for women relates to the behaviors of their male sex partners, and these risks of partners may be unknown to women. Additionally, the completeness of data on race/ethnicity in key datasets used to document PrEP users in the US is limited leading to bias in our estimates. The proposed analysis will (1) determine the characteristics of women based on their partnerships that are indications for PrEP, particularly those indications unrecognized by women and their healthcare providers, 2) use multiple imputation to complete race/ethnicity data in current pharmaceutical use datasets to better understand the current racial/ethnic distribution of women PrEP users, and 3) analyze spatio-temporal patterns of PrEP uptake among women in the United States. Taken together, the goal of this proposal is to advance our understanding of among whom PrEP is needed, racial/ethnicity distributions among whom PrEP is currently being utilized, and where uptake is disparate considering risk factors for HIV infection.