An observational cohort study evaluating PrEP reach, engagement and persistence through a community-based mobile clinic in Miami-Dade County, Florida

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2024-10-14 DOI:10.1002/jia2.26362

Susanne Doblecki-Lewis, Ariana Johnson, Katherine Klose, Katherine King, Gilianne Narcisse, Stefani Butts, Patrick Whiteside, Erin Kobetz, Mario Stevenson

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引用次数: 0

Abstract

Introduction

Barriers to pre-exposure prophylaxis (PrEP) access have limited its reach to priority populations. Community-based mobile clinics have potential to broaden PrEP engagement. We evaluated reach and persistence for fixed and mobile clinic cohorts in Miami-Dade County, Florida.

Methods

This observational cohort study analysed data from 1896 clients engaged through our fixed or mobile clinic from August 2018 to March 2023. Services were offered at no cost to clients. The same staff and package of barrier-lowering strategies was deployed across fixed and mobile clinic sites. Chi-square and Fisher's exact test or the Kruskal–Wallis test were used to test for differences in characteristics across sites as well as across services sought. Kaplan–Meier curves were generated to evaluate persistence on PrEP and in care, defined as completion of at least one clinic visit (including PrEP prescribing, for PrEP persistence, or for any reason, for persistence in care) within 24 weeks of the prior visit. Cox proportional hazards models were used to evaluate risk factors for discontinuation of PrEP or clinic care by 48 weeks by gender, race, ethnicity, insurance status and site.

Results

The fixed and mobile clinics reached 781 and 1109 clients, respectively, during the study period. The median client age was 35 years; the majority (70.4%) of clients were cisgender men, identified as Hispanic/Latino (62.5%) and were men who have sex with men (54.5%). The mobile clinic extended reach to a higher proportion of cisgender women (32.1% mobile vs. 12.9% for fixed clinic), Black clients (34.5% vs. 13.1%) and older clients (median 37 vs. 33 years) compared with the fixed setting. Uninsured individuals, men and those who initiated services in the mobile clinic were more likely to continue PrEP to 48 weeks (HR: 1.20, p = 0.01; HR: 2.02, p<0.01; HR: 1.68, p<0.01, respectively). Persistence did not differ by race or ethnicity.

Conclusions

A mobile clinic strategy for PrEP engagement can increase reach to key populations underrepresented in HIV prevention care including cisgender women and Black clients. Persistence in PrEP was increased for the mobile clinic cohort, suggesting an additional benefit to this modality beyond other barrier-lowering strategies employed in our fixed and mobile clinics.

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一项观察性队列研究，通过佛罗里达州迈阿密-戴德县的社区流动诊所评估 PrEP 的覆盖面、参与度和持续性

导言：接触前预防疗法（PrEP）的使用障碍限制了其在重点人群中的普及。基于社区的流动诊所有可能扩大 PrEP 的覆盖范围。我们评估了佛罗里达州迈阿密-戴德县固定诊所和流动诊所队列的覆盖范围和持续性。方法这项观察性队列研究分析了 2018 年 8 月至 2023 年 3 月期间通过我们的固定诊所或流动诊所参与的 1896 名客户的数据。我们免费为客户提供服务。我们在固定诊所和流动诊所部署了相同的工作人员和一揽子降低障碍策略。采用卡方检验、费雪精确检验或 Kruskal-Wallis 检验来检验不同地点之间以及不同服务之间的特征差异。生成 Kaplan-Meier 曲线以评估 PrEP 和护理的持续性，持续性的定义是在前一次就诊后 24 周内至少完成一次就诊（包括开具 PrEP 处方，以表示 PrEP 的持续性，或出于任何原因，以表示护理的持续性）。根据性别、种族、民族、保险状况和地点，采用 Cox 比例危险模型评估在 48 周内中断 PrEP 或门诊治疗的风险因素。结果在研究期间，固定诊所和流动诊所分别接待了 781 名和 1109 名客户。客户年龄中位数为 35 岁；大多数客户（70.4%）为顺性别男性，62.5% 被认定为西班牙裔/拉丁美洲人，54.5% 为男性同性性行为者。与固定诊所相比，流动诊所覆盖了更高比例的顺性别女性（流动诊所为 32.1%，固定诊所为 12.9%）、黑人客户（34.5%，固定诊所为 13.1%）和年龄较大的客户（中位数为 37 岁，固定诊所为 33 岁）。无保险的个人、男性和在流动诊所开始接受服务的人更有可能将 PrEP 持续到 48 周（HR：1.20，p = 0.01；HR：2.02，p<0.01；HR：1.68，p<0.01）。持续率没有种族或民族差异。结论采用流动诊所策略开展 PrEP 治疗，可以增加对艾滋病毒预防护理中代表性不足的关键人群（包括顺性别女性和黑人客户）的覆盖率。流动诊所队列中的 PrEP 持续率有所提高，这表明除了我们的固定诊所和流动诊所采用的其他降低障碍策略外，这种模式还能带来额外的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.