Aneurin Bevan University Health Board, Cordell Centre, Royal Gwent Hospital, Newport, UK.
Public Health Wales, Cardiff, UK.
Sex Transm Infect. 2018 Aug;94(5):327-330. doi: 10.1136/sextrans-2018-053561. Epub 2018 Jun 27.
Pre-exposure prophylaxis for HIV (PrEP) has been shown to reduce transmission of HIV in a number of trials; however, there is limited evidence regarding the optimal way to deliver PrEP through pre-existing UK services, particularly through fully integrated drop-in sexual health service models. PrEP in the form of Truvada was launched in Wales in July 2017. We set up a PrEP service to be delivered via our drop-in integrated sexual reproductive health service. In the first 5 months of PrEP service provision, we found unforeseen levels of comorbidity, polypharmacy and renal impairment in our cohort of PrEP patients. As a result, we have altered our service model and all patients are now followed up in booked appointment PrEP clinics run by members of the HIV team. Those patients with estimated glomerular filtration rate (eGFR) of 60-70 mL/min or with eGFR of 60-80 mL/min and with comorbidities impacting on renal function are monitored every 4-6 weeks initially, and PrEP has been incorporated into our pre-existing virtual HIV renal clinic for discussion with a renal physician. The PrEP team clinicians report that monitoring and managing the PrEP cohort is now easier in its appointment-only format, although some patients have reported that they would prefer a drop-in system.
暴露前预防（PrEP）已被多项试验证明可降低 HIV 的传播；然而，关于通过英国现有的服务提供 PrEP 的最佳方式（特别是通过完全整合的即到即服务模式）的证据有限。2017 年 7 月，在威尔士推出了以特鲁瓦达（Truvada）为形式的 PrEP。我们建立了一项 PrEP 服务，通过我们的即到即服务综合生殖健康服务提供。在 PrEP 服务提供的头 5 个月，我们发现我们的 PrEP 患者队列中出现了预料之外的合并症、多药治疗和肾功能损害。因此，我们改变了服务模式，现在所有患者都在由 HIV 团队成员管理的预约 PrEP 诊所中接受随访。那些估计肾小球滤过率（eGFR）为 60-70mL/min 或 eGFR 为 60-80mL/min 且合并症影响肾功能的患者最初每 4-6 周监测一次，PrEP 已纳入我们现有的虚拟 HIV 肾脏诊所，由肾脏医生进行讨论。PrEP 团队临床医生报告说，在预约制模式下，监测和管理 PrEP 队列现在更容易了，尽管一些患者表示他们更喜欢即到即服务的系统。
