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AIDS and Behavior

, Volume 23, Issue 7, pp 1803–1811 | Cite as

Health Care Facility Characteristics are Associated with Variation in Human Immunodeficiency Virus Pre-exposure Prophylaxis Initiation in Veteran’s Health Administration

  • Marissa M. MaierEmail author
  • Ina Gylys-Colwell
  • Elliott Lowy
  • Puja Van Epps
  • Michael Ohl
  • Maggie Chartier
  • Lauren A. Beste
Original Paper

Abstract

To quantify health care facility-level variation in pre-exposure prophylaxis (PrEP) use in the Veteran’s Health Administration (VHA); to identify facility characteristics associated with PrEP use. Retrospective analysis of the health care facility-level rate of PrEP initiation in VHA through June 30, 2017. Standardized PrEP initiation rates were used to rank facilities. Characteristics of facilities, prescribers, and PrEP recipients were examined within quartiles. Multiple linear regression was used to identify associations between facility characteristics and PrEP use. We identified 1600 PrEP recipients. Mean PrEP initiation rate was 20.0/100,000 (SD 22.8), ranging from 3.0/100,000 (SD 2.0) in the lowest quartile to 48.1/100,000 (SD 29.1) in the highest. PrEP prescribing was positively associated with proportions of urban dwellers and individuals < 45, tertiary care status, and location. Variability in PrEP uptake across a national health care system highlights opportunities to expand access in non-tertiary care facilities and underserved areas.

Keywords

Pre-exposure prophylaxis HIV Health care Initiation 

Resumen

Para cuantificar la variación a nivel de las instalaciones de atención médica en el uso de la profilaxis previa a la exposición (PrEP) en la Administración de Salud para Veteranos (VHA); para identificar las características de las instalaciones asociadas con el uso de PrEP. Análisis retrospectivo de la tasa de nivel de establecimiento de atención médica de inicio de PrEP en VHA hasta el 30 de junio de 2017. Se utilizaron índices de inicio de PrEP estandarizados para clasificar los establecimientos. Las características de las instalaciones, los prescriptores y los receptores de PrEP se examinaron dentro de los cuartiles. Se utilizó regresión lineal múltiple para identificar asociaciones entre las características de la instalación y el uso de PrEP. Identificamos 1600 beneficiarios de PrEP. La tasa media de iniciación de PrEP fue de 20.0/100.000 (SD 22.8), variando desde 3.0/100.000 (SD 2.0) en el cuartil más bajo hasta 48.1/100.000 (SD 29.1) en el más alto. La prescripción de PrEP se asoció positivamente con proporciones de habitantes urbanos e individuos < 45, estado terciario y ubicación. La variabilidad de la captación de PrEP a través de un sistema nacional de atención de salud resalta las oportunidades para ampliar el acceso en instalaciones no terciarias y áreas subatendidas o comunidades con bajos recursos.

Notes

Funding

This work was prepared independently with no external funding source. The authors are employees of the Veterans Health Administration, which supported their work.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors. Under guidance from the VHA Office of Research Oversight (ORO), the HIV, Hepatitis, and Related Conditions Office in Specialty Care Services has the authority to perform the analyses presented here as part of their healthcare operations work which does not require Institutional Review Board approval.

Supplementary material

10461_2018_2360_MOESM1_ESM.docx (14 kb)
Electronic supplementary material 1 (DOCX 14 kb)

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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  1. 1.VA Portland Health Care System, Infectious DiseasesPortlandUSA
  2. 2.HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care ServicesVeterans Health AdministrationWashingtonUSA
  3. 3.Division of Infectious DiseasesOregon Health and Science UniversityPortlandUSA
  4. 4.VA Puget Sound Health Care System, Health Services Research and DevelopmentSeattleUSA
  5. 5.School of Public HealthUniversity of WashingtonSeattleUSA
  6. 6.Geriatric Research Education and Clinical CenterLouis Stokes Cleveland VA Medical CenterClevelandUSA
  7. 7.Division of Infectious DiseaseCase Western School of MedicineClevelandUSA
  8. 8.Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityUSA
  9. 9.Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa CityIowa CityUSA
  10. 10.VA Puget Sound Health Care System, General Medicine ServiceSeattleUSA
  11. 11.Division of General Internal MedicineUniversity of WashingtonSeattleUSA

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