Feasibility of Implementing a Low-Barrier Long-Acting Injectable Antiretroviral Program for HIV Treatment and Prevention for People Experiencing Homelessness.

IF 2.9 3区 医学 Q3 IMMUNOLOGY
Nicky J Mehtani, Alix Strough, Sarah Strieff, Barry Zevin, Joanna Eveland, Elise D Riley, Monica Gandhi
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引用次数: 0

Abstract

Background: Long-acting (LA) antiretrovirals may provide meaningful benefit to people who use drugs and people experiencing homelessness (PEH) who face disproportionate structural and psychosocial barriers in adhering to daily oral HIV antiretroviral therapy or pre-exposure prophylaxis (PrEP), but their use in these populations has not been studied.

Setting: The Maria X. Martinez Health Resource Center is a low-barrier (eg, no appointment) community-based clinic serving San Francisco PEH.

Methods: A multidisciplinary care model with robust monitoring and outreach support was developed to provide LA antiretroviral therapy (ART) and LA-PrEP to eligible patients experiencing difficulties adhering to oral antiretrovirals. Feasibility was assessed by evaluating the rates of HIV viremia and on-time injections among patients receiving LA antiretrovirals over the first 24 months of program implementation.

Results: Between November 2021 and November 2023, 33 patients initiated LA-ART or LA-PrEP (median age, 37 years; 27% transgender/nonbinary; 73% non-White; 27% street homeless; 52% sheltered homeless; 30% with opioid use disorder; 82% with methamphetamine use disorder). Among 18 patients with HIV, 14 initiated LA-ART injections with detectable viremia (median CD4 count, 340 cells/mm 3 ; mean log 10 viral load, 3.53; SD, 1.62), 8 had never previously been virally suppressed, and all but 1 achieved or maintained virologic suppression (mean, 9.67 months; SD, 8.30). Among 15 LA-PrEP patients, all remained HIV negative (mean, 4.73 months; SD, 2.89). Of 224 total injections administered, 8% were delayed >7 days.

Discussion: The implementation of LA antiretrovirals is feasible in low-barrier, highly supportive clinical settings serving vulnerable PEH. Expansion of such programs will be critical in ending the HIV epidemic.

为无家可归者实施低障碍长效抗逆转录病毒注射剂治疗和预防艾滋病计划的可行性。
背景:长效(LA)抗逆转录病毒药物可为吸毒者和无家可归者(PEH)带来切实的益处,他们在坚持每日口服 HIV 抗逆转录病毒疗法(ART)或暴露前预防疗法(PrEP)方面面临着巨大的结构性和社会心理障碍,但这些药物在这些人群中的使用尚未得到研究:玛丽亚-马丁内斯健康资源中心(Maria X. Martinez Health Resource Center)是一家为旧金山 PEH 服务的低门槛(如无需预约)社区诊所:方法:建立了一个多学科护理模式,并提供强有力的监测和外展支持,为难以坚持口服抗逆转录病毒药物的合格患者提供 LA-ART 和 LA-PrEP。在计划实施的前 24 个月中,通过评估接受 LA 抗逆转录病毒治疗的患者的艾滋病病毒感染率和按时注射率来评估其可行性:2021 年 11 月至 2023 年 11 月期间,33 名患者开始接受 LA-ART 或 LA-PrEP 治疗(年龄中位数为 37 岁;27% 为变性人/非二元性;73% 为非白人;27% 为街头无家可归者;52% 为有庇护所的无家可归者;30% 患有阿片类药物使用障碍;82% 患有甲基苯丙胺使用障碍)。在 18 名艾滋病病毒感染者中,14 人开始注射 LA-ART 时检测到了病毒血症(CD4 细胞计数中位数为 340 cells/mm3;病毒载量 log10 平均值为 3.53;标准差 [SD] 为 1.62),8 人以前从未抑制过病毒,除一人外,其他人都达到或维持了病毒学抑制(平均 9.67 个月;标准差为 8.30)。在 15 名 LA-PrEP 患者中,所有人都保持了 HIV 阴性(平均为 4.73 个月;标准差为 2.89)。在总共 224 次注射中,8% 的注射延迟了 7 天以上:讨论:在为弱势 PEH 提供服务的低门槛、高支持性临床环境中实施 LA 抗逆转录病毒疗法是可行的。扩大此类计划对于遏制 HIV 流行至关重要。
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来源期刊
CiteScore
5.80
自引率
5.60%
发文量
490
审稿时长
3-6 weeks
期刊介绍: JAIDS: Journal of Acquired Immune Deficiency Syndromes​ seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.
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