Adams Leah M, Balderson Benjamin H
a Group Health Research Institute , Seattle , WA , USA.
AIDS Care. 2016 Sep;28(9):1154-8. doi: 10.1080/09540121.2016.1153595. Epub 2016 Feb 26.
Pre-exposure prophylaxis (PrEP), the antiretroviral treatment regimen for HIV-negative people at high risk of acquiring HIV, has demonstrated efficacy across clinical trials in several patient populations. The Centers for Disease Control (CDC) have released detailed guidelines to aid providers in prescribing PrEP for their high-risk patients, including men who have sex with men (MSM), high-risk heterosexuals, and injection drug users (IDUs). Given that much attention in PrEP has focused on MSM patients, the present study used an online survey to assess factors involved in HIV care providers' (n = 363) decisions about prescribing PrEP, along with their willingness to prescribe PrEP to patients from various risk populations (e.g., MSM, heterosexuals, IDUs). The efficacy of PrEP was an important factor in providers' decisions about prescribing PrEP, as were considerations about patients' adherence to the regimen, regular follow-up for care, and medication costs. This survey's findings also suggest that providers' willingness to prescribe PrEP varies by patient group, with providers most willing to initiate the regimen with MSM who have an HIV-positive partner, and least willing to prescribe to high-risk heterosexuals or IDUs. In the context of the current CDC recommendations for PrEP that include MSM, heterosexuals, and IDUs, examining providers' rationales for and barriers against supporting this HIV prevention strategy across patient groups merits further attention.
暴露前预防(PrEP),即针对有感染HIV高风险的HIV阴性人群的抗逆转录病毒治疗方案,已在多项临床试验中对多个患者群体显示出疗效。美国疾病控制中心(CDC)发布了详细指南,以帮助医疗服务提供者为其高风险患者开具PrEP处方,这些患者包括男男性行为者(MSM)、高风险异性恋者和注射吸毒者(IDU)。鉴于PrEP的很多关注都集中在男男性行为者患者身上,本研究通过在线调查评估了HIV护理提供者(n = 363)开具PrEP处方的决策所涉及的因素,以及他们为来自不同风险人群(如男男性行为者、异性恋者、注射吸毒者)的患者开具PrEP的意愿。PrEP的疗效是提供者开具PrEP处方决策的一个重要因素,患者对治疗方案的依从性、定期随访护理以及药物成本等因素也是如此。这项调查的结果还表明,提供者开具PrEP的意愿因患者群体而异,提供者最愿意为有HIV阳性伴侣的男男性行为者启动该治疗方案,而最不愿意为高风险异性恋者或注射吸毒者开具处方。在CDC目前关于PrEP的建议涵盖男男性行为者、异性恋者和注射吸毒者的背景下,审视提供者在不同患者群体中支持这一HIV预防策略的理由和障碍值得进一步关注。