Department of Global Health, University of Washington, Seattle, WA, USA.
Department of Epidemiology, University of Washington, Seattle, WA, USA.
J Int AIDS Soc. 2019 Aug;22(8):e25370. doi: 10.1002/jia2.25370.
Questions remain whether HIV pre-exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population-level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence, and persistence and their combined impact on the epidemic.
Targets for PrEP uptake must be based on the local HIV epidemic and will depend on appropriate estimates of the key populations at risk for HIV. However, there is evidence that targets, once established, can successfully be met and that uptake may increase with awareness. Messaging around adherence should include that daily adherence is the goal (except for those MSM for whom event-driven dosing is a good fit), but perfect adherence should not be a barrier. Ideally, clients persist on PrEP for as long as they are at risk for HIV. While PrEP will be most effective when coverage is focused on high-risk populations, normalizing rather than stigmatizing PrEP will be highly beneficial.
While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.
HIV 暴露前预防（PrEP）能否转化为成功的公共卫生干预措施，从而降低人群 HIV 感染率，这一问题仍存在争议。我们以 HIV 治疗和避孕为例，讨论了 PrEP 的使用率、坚持率和持续率的预期及其对疫情的综合影响。
PrEP 的使用目标必须基于当地的 HIV 疫情，并将取决于对高危 HIV 人群的适当估计。然而，有证据表明，一旦确定了目标，就可以成功实现，并且随着认识的提高，使用率可能会增加。关于坚持用药的信息应包括，每天坚持用药是目标（除非对那些适合偶发用药的男男性行为者而言），但完美的坚持不应成为障碍。理想情况下，只要客户有感染 HIV 的风险，就应坚持服用 PrEP。虽然 PrEP 在高危人群中具有最大的效果，但将 PrEP 正常化而非污名化将是非常有益的。
虽然 PrEP 的实施存在许多挑战，但我们关注的是使用率、坚持率和持续率这三个关键步骤，它们是可以提高覆盖率和降低 HIV 感染率的可衡量过程。
