Abstract：
Testing guidelines for initiation of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) have been developed to ensure appropriate use of PrEP, such as among those with renal dysfunction or at high risk of seroconversion. While many studies have looked at the trends of use of PrEP in the United States, little is known about compliance with these guidelines, the quality of care of PrEP at a national level, or what provider-level factors are associated with high-quality care. We conducted a retrospective claims analysis of providers of commercially insured new users of PrEP between January 1, 2011, and December 31, 2019. Of the 4200 providers, quality of care was low, with only 6.4% having claims for ≥60% of guideline-recommended testing for their patients in the testing window for all visits. More than half of the providers did not have claims for HIV testing at initiation of PrEP and ≥40% did not for sexually transmitted infections at both initiation and follow-up visits. Even when extending the testing window, quality of care remained low. Logistic regression models found no association between provider type and high quality of care, but did find that providers with one PrEP patient were more likely to have higher quality of care than those with multiple patients for all tests [adjusted odds ratio 0.47 (95% confidence interval: 0.33-0.67)]. The study findings suggest further training and interventions, such as integrated test ordering through electronic health records, are needed to increase quality of care for PrEP and ensure appropriate monitoring of patients.
摘要：
已经制定了开始人类免疫缺陷病毒（HIV）暴露前预防（PrEP）的测试指南，以确保PrEP的适当使用。例如肾功能不全或血清转化风险高的患者。虽然许多研究已经观察了美国使用PrEP的趋势，对遵守这些准则知之甚少，全国范围内的PrEP护理质量，或者哪些提供者级别的因素与高质量护理相关。我们在2011年1月1日至2019年12月31日期间对PrEP的商业保险新用户的提供者进行了回顾性索赔分析。在4200家供应商中，护理质量很低，在所有访视的测试窗口中，只有6.4%的患者申请了≥60%的指南推荐测试。超过一半的提供者在开始PrEP时没有要求进行HIV检测，而≥40％的提供者在开始和随访时都没有性传播感染。即使在扩展测试窗口时，护理质量仍然很低。Logistic回归模型发现提供者类型与高质量护理之间没有关联，但确实发现,在所有测试中,有1例PrEP患者的提供者比有多名患者的提供者更有可能获得更高的护理质量[校正比值比0.47(95%置信区间:0.33-0.67)].研究结果表明，进一步的培训和干预措施，例如通过电子健康记录进行综合测试订购，需要提高PrEP的护理质量，并确保对患者进行适当的监测。
