Mayer Kenneth H, Hosek Sybil, Cohen Stephanie, Liu Albert, Pickett Jim, Warren Mitchell, Krakower Douglas, Grant Robert
The Fenway Institute, Fenway Health, Boston, MA, USA.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Int AIDS Soc. 2015 Jul 20;18(4 Suppl 3):19980. doi: 10.7448/IAS.18.4.19980. eCollection 2015.
After the initial approval of the use of tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) by the US Food and Drug Administration in 2012 for anti-HIV pre-exposure prophylaxis (PrEP), uptake was initially limited, but more recent community surveys and expert opinion suggest wider acceptance in some key populations.
Demonstration projects are underway to determine the best practices in the United States to identify at-risk individuals in primary care and sexually transmitted disease clinics who could benefit from PrEP. Studies of PrEP in combination with behavioural interventions are being evaluated. Studies to evaluate the use of PrEP by HIV-uninfected women in HIV-discordant couples interested in safe conception are also getting underway. The optimal deployment of PrEP as part of a comprehensive national HIV/AIDS strategy in the United States has been limited by lack of knowledge among some at-risk people and by some medical providers indicating that they do not feel sufficiently knowledgeable and comfortable in prescribing PrEP. Studies are underway to determine how to assist busy clinicians to determine which of their patients could benefit from PrEP. Although most federal health insurance programmes will cover most of the costs associated with PrEP, underinsured patients in states that have not enacted health reform face additional challenges in paying for PrEP medication and appropriate clinical monitoring.
PrEP implementation in the United States is a work in progress, with increasing awareness and uptake among some individuals in key populations.
2012年美国食品药品监督管理局首次批准使用替诺福韦酯-恩曲他滨（TDF/FTC）进行抗HIV暴露前预防（PrEP）后，其应用最初受到限制，但最近的社区调查和专家意见表明，在一些关键人群中接受度有所提高。
美国正在开展示范项目，以确定在初级保健和性传播疾病诊所中识别可能从PrEP中受益的高危个体的最佳做法。PrEP与行为干预相结合的研究正在评估中。评估未感染HIV的女性在希望安全受孕的HIV异性伴侣中使用PrEP情况的研究也在进行中。在美国，PrEP作为全面国家HIV/AIDS战略一部分的最佳部署受到一些高危人群知识匮乏以及一些医疗服务提供者表示他们在开具PrEP处方时感觉知识不足且不自在的限制。正在开展研究以确定如何帮助忙碌的临床医生确定哪些患者可能从PrEP中受益。尽管大多数联邦医疗保险计划将涵盖与PrEP相关的大部分费用，但在尚未实施医疗改革的州，保险不足的患者在支付PrEP药物费用和进行适当临床监测方面面临额外挑战。
在美国，PrEP的实施仍在进行中，一些关键人群中的认识和应用正在增加。
