Division of Infectious Diseases, University of Colorado, Aurora, CO, USA.
School of Medicine, University of Colorado, Aurora, CO, USA.
J Gen Intern Med. 2019 Jul;34(7):1279-1288. doi: 10.1007/s11606-019-04958-z. Epub 2019 Apr 29.
Health disparities exist in HIV risk in the USA among the lesbian-gay-bisexual-transgender-queer (LGBTQ) community. There is also scarce literature on curricula for HIV prevention and pre-exposure prophylaxis (PrEP) for trainees.
To create a curriculum to train residents to perform inclusive sexual history taking and HIV prevention care. The curriculum covers sexual history, LGBTQ health, sexually transmitted infections, and HIV risk assessment and risk reduction counseling including use of PrEP.
A dedicated PrEP Clinic was created within an Academic Medical Center Outpatient HIV Clinic. Patients were primarily LGBTQ identified, but also included HIV sero-discordant couples, cisgender individuals, heterosexual invididuals, and those with experience of homelessness, sex work, and substance abuse.
Thirty-four internal medicine residents completed the course between November 2017 and May 2018.
The curriculum was delivered as Just in Time Teaching (JiTT) via online virtual patient cases followed by directly observed clinical care at a large urban PrEP clinic.
The effectiveness of the curriculum was assessed through paired pre/post-self-assessment surveys (n = 19), additional post-surveys on the online modules (n = 22), and interviews (n = 9). Many respondents reported no prior training or inadequate prior training in the course content. As a result of the course, participants reported statistically significant increased confidence and comfort in all seven HIV prevention topic areas, with the greatest gains in safe sex counseling for LGBTQ patients and in discussing PrEP (mean changes of 1.21, 1.58 on 5-point Likert scale, respectively, p < 0.0001). Six of nine interviewees post-course had applied what they learned to patient care; five indicated their learning would benefit patients.
An HIV prevention curriculum focused on cultural humility in care can improve trainee's skills in HIV risk reduction counseling, including PrEP, among all patients including those identifying as LGBTQ.
在美国，男女同性恋、双性恋、跨性别、酷儿（LGBTQ）群体的艾滋病毒风险存在差异。关于针对学员的艾滋病毒预防和暴露前预防（PrEP）课程的文献也很少。
创建一个培训居民进行包容的性史采集和艾滋病毒预防护理的课程。该课程涵盖性史、LGBTQ 健康、性传播感染以及艾滋病毒风险评估和风险降低咨询，包括使用 PrEP。
在学术医疗中心门诊艾滋病毒诊所内设立了一个专门的 PrEP 诊所。患者主要是 LGBTQ 人群，但也包括 HIV 血清不一致的夫妇、顺性别个体、异性恋个体以及有流浪、性工作和药物滥用经历的个体。
34 名内科住院医师于 2017 年 11 月至 2018 年 5 月完成了该课程。
该课程通过在线虚拟患者病例作为及时教学（JiTT）进行，然后在大型城市 PrEP 诊所进行直接观察的临床护理。
通过配对的课前/课后自我评估调查（n=19）、对在线模块的额外课后调查（n=22）和访谈（n=9）评估课程的效果。许多受访者报告说，他们在课程内容方面没有接受过培训或培训不足。由于该课程，参与者报告说，在所有七个艾滋病毒预防主题领域的信心和舒适度都有统计学上显著提高，在 LGBTQ 患者的安全性行为咨询和讨论 PrEP 方面的提高最大（5 点李克特量表的平均变化分别为 1.21 和 1.58，p<0.0001）。九名受访者中的六名在课后将所学应用于患者护理；五名表示他们的学习将使患者受益。
以关怀文化谦逊为重点的艾滋病毒预防课程可以提高学员在所有患者（包括自认为是 LGBTQ 的患者）中进行艾滋病毒风险降低咨询的技能，包括 PrEP。
