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

摘要 2020年，美国新诊断的艾滋病毒病例中，女性占了18%，而在此之前，女性仅占7.4% 暴露预防(PrEP)用户。此外，2020年被诊断出感染艾滋病毒的女性中，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，提供一种 致力于美国卫生与公众服务部的重大公共卫生机会 宣布了结束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是 女性与她们的男性性伴侣的行为有关，而伴侣的这些风险可能是未知的 女人。此外，用于记录PrEP用户的关键数据集中关于种族/族裔的数据的完整性 在美国是有限的，这导致了我们估计的偏差。拟议的分析将(1)确定特征 基于其伙伴关系的妇女，这是PrEP的指征，特别是那些未被识别的指征 由女性和她们的医疗保健提供者，2)使用多重归因来完成当前 药学使用数据集来更好地了解目前PrEP女性使用者的种族/民族分布， 3)分析美国女性PrEP摄取的时空模式。加在一起， 这项建议的目标是促进我们对谁需要PrEP的理解，种族/民族 目前正在使用PrEP的分布，以及考虑到风险因素而吸收不同的分布 用于艾滋病病毒感染。

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.