澳大利亚跨学科医疗保健提供者对更广泛的暴露前预防 (PrEP) 获得对 uptake 和服务提供的影响的看法：一项定性研究。
Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study.
机构信息
School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia.
Blood Borne Virus and Sexually Transmissible Infection Unit, Communicable Disease Branch, Queensland Health, Butterfield Street, Herston, Qld 4006, Australia.
出版信息
Sex Health. 2020 Dec;17(6):485-492. doi: 10.1071/SH20156.
UNLABELLED
Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers' (HCP) knowledge and preparedness to prescribe PrEP remains limited.
METHODS
Semistructured interviews, conducted before PBS listing (October 2016-April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study.
RESULTS
Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia's universal healthcare insurance system).
CONCLUSIONS
Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.
背景
背景：在澳大利亚政府补贴的药品福利计划（PBS）中增加艾滋病毒预防暴露前预防（PrEP），使任何医生或护士从业者都可以开处方，并增加了可获得性选择。然而，对于澳大利亚医疗保健提供者（HCP）的知识和准备情况，了解其开具 PrEP 的情况仍然有限。
方法
在 PBS 上市前（2016 年 10 月至 2017 年 4 月）进行的半结构式访谈，探讨了参与昆士兰 PrEP 暴露前预防试验的 51 名多学科 HCP 对 PrEP 的知识和处方经验。
结果
主题分析显示，参与者认为 PrEP 是一种必要的艾滋病毒预防选择，但他们担心预防信息混乱和潜在的风险补偿。临床能力、耻辱感、文化规范、农村获得途径和与 PrEP 相关的费用被确定为获得和采用的障碍。这些障碍中的一些可能会因 PBS 上市而得到解决；尽管如此，许多专家仍然担心没有性健康经验的全科医生准备好开 PrEP。参与者认为需要对所有 HCP 进行教育，实施多学科供应模式，并为弱势群体和不符合医疗保险（澳大利亚全民医疗保险系统）资格的人提供及时获得 PrEP 的机会。
结论
尽管 PrEP 在 PBS 上的上市解决了获得途径的结构性障碍，但本研究强调了护士和其他跨学科医疗工作者在提供 PrEP 方面的作用，以解决仍然影响某些人群获得艾滋病毒预防措施的社会文化障碍。这些发现将为进一步的专业培训提供信息，因为 PrEP 在性健康专科服务之外更广泛地获得和需求。需要进一步的工作来确保初级保健劳动力有能力在不同地点和人群中提供 PrEP，以确保安全。
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