Sullivan Patrick S, Jones Jeb, Kishore Nishant, Stephenson Rob
Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
Curr HIV/AIDS Rep. 2015 Dec;12(4):481-8. doi: 10.1007/s11904-015-0293-5.
Men who have sex with men (MSM) are at disproportionate risk for HIV infection globally. The past 5 years have seen considerable advances in biomedical interventions to reduce the risk of HIV infection. To be impactful in reducing HIV incidence requires the rapid and expansive scale-up of prevention. One mechanism for achieving this is technology-based tools to improve knowledge, acceptability, and coverage of interventions and services. This review provides a summary of the current gap in coverage of primary prevention services, how technology-based interventions and services can address gaps in coverage, and the current trends in the development and availability of technology-based primary prevention tools for use by MSM. Results from agent-based models of HIV epidemics of MSM suggest that 40-50 % coverage of multiple primary HIV prevention interventions and services, including biomedical interventions like preexposure prophylaxis, will be needed to reduce HIV incidence among MSM. In the USA, current levels of coverage for all interventions, except HIV testing and condom distribution, fall well short of this target. Recent findings illustrate how technology-based HIV prevention tools can be used to provide certain kinds of services at much larger scale, with marginal incremental costs. A review of mobile apps for primary HIV prevention revealed that most are designed by nonacademic, nonpublic health developers, and only a small proportion of available mobile apps specifically address MSM populations. We are unlikely to reach the required scale of HIV prevention intervention coverage for MSM unless we can leverage technologies to bring key services to broad coverage for MSM. Despite an exciting pipeline of technology-based prevention tools, there are broader challenges with funding structures and sustainability that need to be addressed to realize the full potential of this emerging public health field.
在全球范围内，男男性行为者（MSM）感染艾滋病毒的风险极高。在过去五年中，生物医学干预措施在降低艾滋病毒感染风险方面取得了显著进展。要有效降低艾滋病毒发病率，需要迅速且广泛地扩大预防规模。实现这一目标的一种机制是利用基于技术的工具来提高干预措施和服务的知晓度、可接受性及覆盖面。本综述总结了当前初级预防服务覆盖方面的差距、基于技术的干预措施和服务如何弥补覆盖差距，以及供男男性行为者使用的基于技术的初级预防工具的开发和可用性现状。基于男男性行为者艾滋病毒流行的主体模型结果表明，若要降低男男性行为者中的艾滋病毒发病率，需对包括暴露前预防等生物医学干预措施在内的多种初级艾滋病毒预防干预措施和服务实现40%至50%的覆盖率。在美国，除艾滋病毒检测和避孕套发放外，所有干预措施目前的覆盖水平均远未达到这一目标。近期研究结果表明，基于技术的艾滋病毒预防工具可用于以较低的边际增量成本大规模提供某些类型的服务。一项针对初级艾滋病毒预防移动应用程序的综述显示，大多数应用程序是由非学术、非公共卫生领域的开发者设计的，只有一小部分可用移动应用程序专门针对男男性行为者群体。除非我们能够利用技术为男男性行为者广泛提供关键服务，否则我们不太可能达到男男性行为者艾滋病毒预防干预措施所需的覆盖规模。尽管基于技术的预防工具前景令人振奋，但要充分发挥这一新兴公共卫生领域的潜力，还需应对资金结构和可持续性等更广泛的挑战。
