Zhang Chen, Mitchell Warton, Xue Ying, LeBlanc Natalie, Liu Yu
School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd., Rochester, New York, 14622, USA.
School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA.
BMC Nurs. 2020 Dec 9;19(1):117. doi: 10.1186/s12912-020-00503-0.
Although pre-exposure prophylaxis (PrEP) was approved for primary HIV prevention by the Federal Drug Administration in 2012, PrEP utilization has been suboptimal. A body of literature and programs has emerged to examine the role of nurse practitioners (NPs), physician assistants and nursing staff in PrEP care. This review aims to understand the current status of non-physician health providers in PrEP care implementation in the United States.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, we conducted a comprehensive literature search using multiple databases to identify peer-reviewed articles that examined the role of non-physician health providers in the implementation of PrEP. Four major databases of studies using observational study design, randomized control trials and mixed-method study design were screened from November 2019 to January 2020 were searched. Two independent reviewers examined eligibility and conducted data extraction. We employed random-effects model aims to capture variances of estimates across studies.
A total of 26 studies with 15,789 health professionals, including NPs (18, 95% CI = 14,24%), physician assistants (6, 95% CI = 2, 10%), nursing staff (26, 95% CI = 18-34%), and physicians (62,95% CI = 45, 75%), were included in the analysis. The odds of prescribing PrEP to patients among NPs were 40% (OR = 1.40, 95% CI = 1.02,1.92) higher than that among physicians, while the likelihood of being willing to prescribe PrEP was similar. On the other hand, the odds of being aware of PrEP (OR = 0.63, 95% CI = 0.46, 0.87) was 37% less in nursing professionals than that among physicians.
Although the limited number and scope of existing studies constrained the generalizability of our findings, the pattern of PrEP care implementation among non-physician health providers was described. To achieve wider PrEP care implementation in the U.S., increasing awareness of PrEP among all health providers including both physicians and non-physicians is a key step.
尽管暴露前预防（PrEP）于2012年被美国食品药品监督管理局批准用于原发性HIV预防，但其利用率一直不理想。已经出现了大量文献和项目来研究执业护士（NPs）、医师助理和护理人员在PrEP护理中的作用。本综述旨在了解美国非医师医疗服务提供者在PrEP护理实施中的现状。
按照系统评价和Meta分析的首选报告项目指南，我们使用多个数据库进行了全面的文献检索，以识别研究非医师医疗服务提供者在PrEP实施中作用的同行评审文章。从2019年11月至2020年1月，对使用观察性研究设计、随机对照试验和混合方法研究设计的四个主要研究数据库进行了筛选。两名独立评审员检查了纳入资格并进行了数据提取。我们采用随机效应模型旨在捕捉各研究估计值的差异。
共有26项研究，涉及15789名医疗专业人员，包括执业护士（18项，95%置信区间=14,24%）、医师助理（6项，95%置信区间=2,10%）、护理人员（26项，95%置信区间=18 - 34%）和医生（62项，95%置信区间=45,75%），纳入了分析。执业护士向患者开具PrEP的几率比医生高40%（OR = 1.40，95%置信区间=1.02,1.92），而愿意开具PrEP的可能性相似。另一方面，护理专业人员知晓PrEP的几率（OR = 0.63，95%置信区间=0.46,0.87）比医生低37%。
尽管现有研究的数量和范围有限，限制了我们研究结果的普遍性，但描述了非医师医疗服务提供者中PrEP护理实施的模式。为了在美国更广泛地实施PrEP护理，提高包括医生和非医生在内的所有医疗服务提供者对PrEP的认识是关键一步。
