Engaging United States Black Communities in HIV Pre-exposure Prophylaxis: Analysis of a PrEP Engagement Cascade
| Autor: | Donielle Sturgis, Oumar H. Gaye, Rahab Wahome, Mayla Jackson, Helena Kwakwa, Gina Walton, Sophia Bessias |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Referral Anti-HIV Agents Population Human immunodeficiency virus (HIV) HIV Infections Health Promotion medicine.disease_cause 03 medical and health sciences Pre-exposure prophylaxis Sex Factors 0302 clinical medicine Risk Factors Community health center Humans Mass Screening Medicine 030212 general & internal medicine education Referral and Consultation Philadelphia Black women education.field_of_study business.industry Community Health Centers General Medicine Patient Acceptance of Health Care 030112 virology Urban community United States Black or African American Family medicine Cohort Female Pre-Exposure Prophylaxis business |
| Zdroj: | Journal of the National Medical Association. 110:480-485 |
| ISSN: | 0027-9684 |
| DOI: | 10.1016/j.jnma.2017.12.006 |
| Popis: | National PrEP utilization analyses show US non-Hispanic Blacks accessing PrEP at disproportionately low rates given the higher HIV prevalence among Blacks, and in comparison to utilization by non-Hispanic Whites. Women also are underrepresented among PrEP utilizers, especially Black women. We examine the process of accessing PrEP for a majority Black population in an urban community health center setting.In the Philadelphia city health centers, patients referred for PrEP were followed through six steps of accessing PrEP: referral, patient contact by a PrEP team, maintained interest by patients, scheduling of screening appointments, attending screening appointments, and initiating PrEP. Chi-squared tests were performed at each stage to identify gender differences in drop-off at each step.Between August 2014 and December 2015, 14% of 785 patients referred for PrEP initiated. Women constituted 37.8% of referrals. A smaller majority of Blacks initiated (84.6% of females, 69.5% of males) than were referred (94.5% of females, 88.1% of males). Prior knowledge of PrEP was associated with screening (68% of those with prior knowledge screened, compared with 29.6% of those without prior knowledge,Χ2 p0.0001). Higher initiation:referral ratios were noted for self-referrals, and for those referred by clinicians, peers and partners.In a diverse cohort in a community health center setting, myriad barriers resulted in a 14% initiation rate for persons at elevated risk for HIV who were referred for PrEP. These barriers led to disproportionately fewer non-Hispanic Blacks and women initiating PrEP. Efforts to better engage Blacks and women in PrEP care are urgently needed, and may include better dissemination of PrEP-related information in Black communities and to women, and training of clinicians serving Black and female populations to improve competency in provision of PrEP care. |
| Databáze: | OpenAIRE |
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