Measuring Oral Pre-exposure Prophylaxis (PrEP) Continuation Through Electronic Health Records During Program Scale-Up Among the General Population in Zambia.

Autor: Heilmann E; PHI/CDC Global Health Fellowship Program, Public Health Institute, Oakland, CA, USA. qng0@cdc.gov.; Division of Global HIV & TB, Centers for Disease Control and Prevention, 351 Independence Avenue, Lusaka, Zambia. qng0@cdc.gov., Okuku J; Division of Global HIV & TB, Centers for Disease Control and Prevention, 351 Independence Avenue, Lusaka, Zambia., Itoh M; Division of Global HIV & TB, Centers for Disease Control and Prevention, 351 Independence Avenue, Lusaka, Zambia., Hines JZ; Division of Global HIV & TB, Centers for Disease Control and Prevention, 351 Independence Avenue, Lusaka, Zambia., Prieto JT; Palantir Technologies, Paris, France., Phiri M; Lusaka Provincial Health Office, Ministry of Health, Lusaka, Zambia., Watala K; Southern Provincial Health Office, Ministry of Health, Choma, Zambia., Nsofu C; Western Provincial Health Office, Ministry of Health, Mongu, Zambia., Luhana-Phiri M; Eastern Provincial Health Office, Ministry of Health, Chipata, Zambia., Vlahakis N; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Kabongo M; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Kaliki B; Division of Global HIV & TB, Centers for Disease Control and Prevention, 351 Independence Avenue, Lusaka, Zambia., Minchella PA; Division of Global HIV & TB, Centers for Disease Control and Prevention, 351 Independence Avenue, Lusaka, Zambia., Musonda B; Ministry of Health, Lusaka, Zambia.
Jazyk: angličtina
Zdroj: AIDS and behavior [AIDS Behav] 2023 Jul; Vol. 27 (7), pp. 2390-2396. Date of Electronic Publication: 2022 Dec 31.
DOI: 10.1007/s10461-022-03966-1
Abstrakt: HIV pre-exposure prophylaxis (PrEP) is being scaled-up in Zambia, but PrEP continuation data are limited by paper-based registers and aggregate reports. Utilization of Zambia's electronic health record (EHR) system, SmartCare, may address this gap. We analyzed individuals aged ≥ 15 years who initiated PrEP between October 2020 and September 2021 in four provinces in Zambia in SmartCare versus aggregate reports. We measured PrEP continuation using Kaplan-Meier survival analysis and Cox proportional hazards models. SmartCare captured 29% (16,791/58,010) of new PrEP clients; 49% of clients continued at one month, and 89% discontinued PrEP by February 2022. Women were less likely than men to discontinue PrEP (adjusted hazard ratio [aHR]: 0.89, 95% CI 0.86-0.92, z = - 6.99, p < 0.001), and PrEP clients aged ≥ 50 years were less likely to discontinue PrEP compared to clients 15-19 years (aHR: 0.53, 95% CI 0.48-0.58, z = - 13.04, p < 0.001). Zambia's EHR is a valuable resource for measuring individual-level PrEP continuation over time and can be used to inform HIV prevention programs.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
Externí odkaz: