1 Department of Psychology, Hunter College of the City University of New York, New York, New York.
2 Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, New York.
AIDS Patient Care STDS. 2019 Jun;33(6):253-261. doi: 10.1089/apc.2018.0290. Epub 2019 May 16.
Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012-2015) and diffusion (2016-2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three "next-wave" challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.
数据表明，美国预防艾滋病毒的暴露前预防（PrEP）项目的传播正在增加；然而，PrEP 获得的持续差距仍然存在。早期的 PrEP 实施浪潮侧重于发展（2012-2015 年）和传播（2016-2018 年）。为了减少差距，下一阶段的 PrEP 实施应该侧重于整合；也就是说，将 PrEP 服务纳入艾滋病毒预防、性健康和初级保健的整体服务。本综述在三个“下一阶段”挑战的背景下分析了 PrEP 实施的文献：增加患者需求、提高提供者的投资和能力，以及提高卫生系统的能力。我们的综述揭示了我们认为对下一阶段 PrEP 实施成功至关重要的五项活动：（1）重新定义 PrEP 资格评估，（2）不强调风险感知作为增加需求的策略，（3）拒绝风险补偿论点，（4）修改指南，使 PrEP 随访不那么繁重，（5）直接关注降低 PrEP 药物成本的策略。本文最后以一个研究-实践伙伴关系为例，说明实施综合实施努力的新方法。
