当前美国关于开具 HIV 暴露前预防（PrEP）处方的指南将许多有风险且有使用 PrEP 意愿的女性排除在外。
Current US Guidelines for Prescribing HIV Pre-exposure Prophylaxis (PrEP) Disqualify Many Women Who Are at Risk and Motivated to Use PrEP.
机构信息
Department of Psychology, George Washington University, Washington, DC.
Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT.
出版信息
J Acquir Immune Defic Syndr. 2019 Aug 1;81(4):395-405. doi: 10.1097/QAI.0000000000002042.
BACKGROUND
US Centers for Disease Control and Prevention clinical guidelines for HIV pre-exposure prophylaxis (PrEP) are widely used to assess patients' PrEP eligibility. The guidelines include 2 versions of criteria-guidance summary criteria and recommended indications criteria-that diverge in a potentially critical way for heterosexually active women: Both require women's knowledge of their own risk behavior, but the recommended indications also require women's knowledge of their partners' HIV risk or recognition of a potentially asymptomatic sexually transmitted infection. This study examined women's PrEP eligibility according to these 2 different versions of criteria across risk and motivation categories.
SETTING/METHODS: HIV-negative women (n = 679) recently engaged in care at Connecticut Planned Parenthood centers were surveyed online in 2017. The survey assessed PrEP eligibility by both versions of Centers for Disease Control and Prevention criteria, HIV risk indicators, PrEP motivation indicators, and sociodemographic characteristics.
RESULTS
Participants were mostly non-Hispanic white (33.9%) or black (35.8%) and had low income (<$30,000/year; 58.3%). Overall, 82.3% were eligible for PrEP by guidance summary criteria vs. 1.5% by recommended indications criteria. Women disqualified by recommended indications criteria included those reporting condomless sex with HIV-positive or serostatus-unknown male partners (n = 27, 11.1% eligible); 1 or more recent sexually transmitted infection(s) (n = 53, 3.8% eligible); multiple sex partners (n = 168, 3.0% eligible); intended PrEP use (n = 211, 2.8% eligible); and high self-perceived risk (n = 5, 0.0% eligible).
CONCLUSION
Current guidelines disqualify many women who could benefit from PrEP and may lead to discrepant assessments of eligibility. Guideline reform is needed to improve clarity and increase women's PrEP access and consequent HIV protection.
背景
美国疾病控制与预防中心（CDC）的 HIV 暴露前预防（PrEP）临床指南被广泛用于评估患者接受 PrEP 的资格。该指南包括 2 种版本的标准-指导摘要标准和推荐适应证标准，这对于异性性行为活跃的女性来说存在潜在的关键分歧：这两种标准都要求女性了解自己的风险行为，但推荐适应证标准还要求女性了解其伴侣的 HIV 风险或识别潜在的无症状性传播感染。本研究根据这两种不同版本的标准，在风险和动机类别中，对女性接受 PrEP 的资格进行了评估。
方法
2017 年，在康涅狄格州计划生育中心接受护理的 HIV 阴性女性（n = 679）通过在线调查接受了调查。该调查通过 CDC 标准的两种版本、HIV 风险指标、PrEP 动机指标和社会人口统计学特征评估了 PrEP 的资格。
结果
参与者主要是非西班牙裔白人（33.9%）或黑人（35.8%），收入较低（<$30,000/年；58.3%）。总体而言，82.3%的女性符合指导摘要标准的 PrEP 资格，而仅有 1.5%的女性符合推荐适应证标准的资格。因推荐适应证标准而被排除的女性包括报告与 HIV 阳性或血清学未知的男性伴侣发生无保护性行为的女性（n = 27，符合条件的女性比例为 11.1%）；1 种或多种近期性传播感染（n = 53，符合条件的女性比例为 3.8%）；有多个性伴侣的女性（n = 168，符合条件的女性比例为 3.0%）；计划使用 PrEP 的女性（n = 211，符合条件的女性比例为 2.8%）；自我认为风险高的女性（n = 5，符合条件的女性比例为 0.0%）。
结论
目前的指南将许多可能受益于 PrEP 的女性排除在外，可能导致资格评估存在差异。需要对指南进行改革，以提高其清晰度，增加女性获得 PrEP 的机会，从而保护她们免受 HIV 感染。
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