Weiser John, Garg Shikha, Beer Linda, Skarbinski Jacek
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Open Forum Infect Dis. 2017 Jan 30;4(1):ofx003. doi: 10.1093/ofid/ofx003. eCollection 2017 Winter.
Clinical trials have demonstrated the effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) for reducing HIV acquisition. Understanding how HIV care providers are prescribing PrEP is necessary to ensure success of this prevention strategy.
During 2013-2014, we surveyed US HIV care providers who also provided care to HIV-negative patients. We estimated percentages who had prescribed PrEP and assessed associations between provider characteristics and PrEP prescribing.
An estimated 26% (95% confidence interval [CI], 20-31) had ever prescribed PrEP. Of these, 74% (95% CI, 61-87) prescribed for men who have sex with men (MSM), 30% (95% CI, 21-39) for women who have sex with men, 23% (95% CI, 9-37) for men who have sex with women, 23% (95% CI, 15-30) for uninfected partners in HIV-discordant couples trying to conceive, and 1% (95% CI, 0-2) for persons who inject drugs. The following provider characteristics were significantly associated with having prescribed PrEP: male vs female (32% vs 16%; adjusted prevalence ratio [aPR], 1.5; 95% CI, 1.0-2.2), lesbian/gay/bisexual vs heterosexual orientation (50% vs 21%; aPR, 2.0; 95% CI, 1.3-2.9), and HIV caseload (>200, 51-200, and ≤50 patients, 39%, 29%, and 14%, respectively; >200 vs ≤50 patients, aPR 2.4, 95% CI 1.1-5.2, and 51-200 vs ≤50 patients, aPR 2.2, 95% CI 1.2-4.0).
In 2013-2014, one quarter of HIV care providers reported having prescribed PrEP, most commonly for MSM and rarely for persons who inject drugs. Lesbian/gay/bisexual providers and male providers were more likely than others to have prescribed PrEP. Additional efforts may enable more providers to prescribe PrEP to underserved clients needing the service.
临床试验已证明人类免疫缺陷病毒（HIV）暴露前预防（PrEP）在降低HIV感染方面的有效性。了解HIV医护人员如何开具PrEP处方对于确保这一预防策略的成功至关重要。
在2013年至2014年期间，我们对同时也为HIV阴性患者提供护理的美国HIV医护人员进行了调查。我们估算了开具过PrEP处方的人员比例，并评估了医护人员特征与PrEP处方开具之间的关联。
估计有26%（95%置信区间[CI]，20 - 31）的医护人员曾开具过PrEP处方。其中，74%（95%CI，61 - 87）为男男性行为者（MSM）开具，30%（95%CI，21 - 39）为与男性发生性行为的女性开具，23%（95%CI，9 - 37）为与女性发生性行为的男性开具，23%（95%CI，15 - 30）为试图受孕的HIV抗体不一致夫妻中的未感染伴侣开具，1%（95%CI，0 - 2）为注射毒品者开具。以下医护人员特征与开具PrEP处方显著相关：男性与女性（32%对16%；调整患病率比[aPR]，1.5；95%CI，1.0 - 2.2），女同性恋/男同性恋/双性恋与异性恋取向（50%对21%；aPR，2.0；95%CI，1.3 - 2.9），以及HIV病例量（>200例、51 - 200例和≤50例患者，分别为39%、29%和14%；>200例患者与≤50例患者相比，aPR 2.4，95%CI 1.1 - 5.2，51 - 200例患者与≤50例患者相比，aPR 2.2，95%CI 1.2 - 4.0）。
在2013年至2014年期间，四分之一的HIV医护人员报告曾开具过PrEP处方，最常见的是为男男性行为者开具，很少为注射毒品者开具。女同性恋/男同性恋/双性恋医护人员和男性医护人员比其他人员更有可能开具PrEP处方。进一步的努力可能会使更多医护人员为需要该服务但未得到充分服务的客户开具PrEP处方。
