Brief Report: A Panel Management and Patient Navigation Intervention Is Associated With Earlier PrEP Initiation in a Safety-Net Primary Care Health System.

Autor:	Spinelli MA; Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, CA., Scott HM; Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, CA.; Bridge HIV, San Francisco Department of Public Health, San Francisco, CA., Vittinghoff E, Liu AY; Bridge HIV, San Francisco Department of Public Health, San Francisco, CA.; Medicine, University of California, San Francisco, San Francisco, CA., Morehead-Gee A; Medicine, University of California, San Francisco, San Francisco, CA., Gonzalez R; Bridge HIV, San Francisco Department of Public Health, San Francisco, CA., Gandhi M; Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, CA., Buchbinder SP; Bridge HIV, San Francisco Department of Public Health, San Francisco, CA.; Medicine, University of California, San Francisco, San Francisco, CA.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2018 Nov 01; Vol. 79 (3), pp. 347-351.
DOI:	10.1097/QAI.0000000000001828
Abstrakt:	Background: Timely pre-exposure prophylaxis (PrEP) initiation is critical in at-risk populations, given that HIV acquisition risk persists during delays. Time to treatment initiation, a key metric in HIV care, has not been explored among PrEP users. Interventions that reduce time to PrEP initiation could prevent HIV infections. Setting: Individuals initiating PrEP in a large primary care health network of 15 clinics, the San Francisco Primary Care Clinics (SFPCC), from July 2012 to July 2017 (N = 411). Methods: We examined factors associated with time from first PrEP discussion with a provider to PrEP initiation date using an adjusted Cox proportional-hazards model, with hazard ratios (HRs) >1 indicating earlier initiation. We also examined the relationship between delayed PrEP initiation and PrEP persistence (staying on PrEP) in an adjusted Cox proportional-hazards model. Results: PrEP users initiated PrEP after a median of only 7 days. However, there were notable outliers, with 29% waiting >30 days and 12% waiting >90 days. In an adjusted proportional-hazards model, a panel management and patient navigation intervention was associated with earlier PrEP initiation [HR: 1.5; 95% confidence interval (CI): 1.1 to 2.0], whereas only other race/ethnicity compared with white race was associated with delayed PrEP initiation (HR: 0.7; 95% CI: 0.5 to 1.0). Delayed PrEP initiation >30 days was associated with shorter PrEP persistence in an adjusted proportional-hazards model (HR: 1.3; 95% CI: 1.0 to 1.7). Conclusions: PrEP initiation within a week is feasible in a primary care safety-net health system. Setting a goal of rapid PrEP initiation, with the support of panel management and patient navigation, could address delays in at-risk groups.
Databáze:	MEDLINE
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