HIV 暴露前预防用药者中错过性传播感染检测的机会：一项系统评价。
Missed opportunities for sexually transmitted infections testing for HIV pre-exposure prophylaxis users: a systematic review.
机构信息
London School of Hygiene and Tropical Medicine, London, UK.
Monash University, Melbourne, Australia.
出版信息
J Int AIDS Soc. 2021 Feb;24(2):e25673. doi: 10.1002/jia2.25673.
INTRODUCTION
Given the synergistic relationship between HIV and sexually transmitted infections (STI), the integration of services has the potential to reduce the incidence of both HIV and STIs. We explored the extent to which STI testing has been offered within HIV pre-exposure prophylaxis (PrEP) programmes worldwide.
METHODS
We conducted a systematic review of PrEP programmes implementing STI testing services in nine databases. We approached PrEP implementers for additional unpublished data and implementation details. Descriptive statistics were used to present the characteristics of STI testing within PrEP programmes. Content analysis of the input from PrEP implementers was conducted to summarize the barriers to and facilitators of STI testing.
RESULTS
Of 9,161 citations, 91 studies conducted in 32 countries were included: 69% from high-income countries (HICs) and 64% from programmes targeting men who have sex with men (MSM) and transgender women (TGW) only. The majority of programmes (70%, 64/91) conducted STI testing before the initiation of PrEP. The most common STIs tested were gonorrhoea (86%, 78/91), chlamydia (84%, 76/91) and syphilis (84%, 76/91). The majority provided STI testing at three-month intervals (70%, 53/76, for syphilis; 70% 53/78, for chlamydia; 68%, 53/78, for gonorrhoea). Relative to low- and middle-income countries (LMICs), a higher proportion of PrEP programmes in HICs offered testing for gonorrhoea (92% vs. 71%, p < 0.05), chlamydia (92% vs. 64%, p < 0.01), syphilis (87% vs. 75%, p < 0.05), hepatitis A (18% vs. 4%, p < 0.05) and hepatitis C (43% vs. 21%, p < 0.05); offered testing for a higher number of STIs (mean 3.75 vs. 3.04, p < 0.05); and offered triple (throat, genital/urine and anorectal) anatomical site screening (54% vs. 18%, p < 0.001). Common implementation challenges included costs, access to STI diagnostics, programme logistics of integrating STI testing into PrEP delivery models and lack of capacity building for staff involved in PrEP provision.
CONCLUSIONS
Significant gaps and challenges remain in the provision of STI testing services within HIV PrEP programmes. We recommend more active integration of STI testing and management into PrEP programmes, supported by standardized practice guidelines, staff capacity building training and adequate funding. This could lead to improved sexual health and HIV outcomes in key populations.
简介
鉴于艾滋病毒和性传播感染（STI）之间的协同关系，服务整合有可能降低艾滋病毒和 STI 的发生率。我们探讨了全球范围内艾滋病毒暴露前预防（PrEP）计划中提供 STI 检测的程度。
方法
我们在九个数据库中对实施 STI 检测服务的 PrEP 计划进行了系统评价。我们联系了 PrEP 实施者以获取额外的未发表数据和实施细节。我们使用描述性统计数据来展示 PrEP 计划中 STI 检测的特征。对 PrEP 实施者的输入进行内容分析，以总结 STI 检测的障碍和促进因素。
结果
在 9161 条引文中，有 91 项研究在 32 个国家进行：其中 69%来自高收入国家（HICs），64%仅针对男男性行为者（MSM）和跨性别女性（TGW）。大多数计划（70%，64/91）在开始 PrEP 前进行 STI 检测。最常见的检测的 STIs 是淋病（86%，78/91）、衣原体（84%，76/91）和梅毒（84%，76/91）。大多数计划每三个月进行一次 STI 检测（梅毒为 70%，53/76；衣原体为 70%，53/78；淋病为 68%，53/78）。与中低收入国家（LMICs）相比，HICs 中 PrEP 计划提供淋病（92% vs. 71%，p<0.05）、衣原体（92% vs. 64%，p<0.01）、梅毒（87% vs. 75%，p<0.05）、甲型肝炎（18% vs. 4%，p<0.05）和丙型肝炎（43% vs. 21%，p<0.05）检测的比例更高；检测的 STIs 数量更多（平均 3.75 种 vs. 3.04 种，p<0.05）；并提供三重（咽喉、生殖/尿液和肛门直肠）解剖部位筛查（54% vs. 18%，p<0.001）。常见的实施挑战包括成本、获得 STI 诊断、将 STI 检测纳入 PrEP 提供模式的计划后勤以及参与 PrEP 提供的工作人员能力建设方面的不足。
结论
艾滋病毒 PrEP 计划中提供 STI 检测服务方面仍存在重大差距和挑战。我们建议更积极地将 STI 检测和管理整合到 PrEP 计划中，辅以标准化实践指南、工作人员能力建设培训和充足的资金。这可能会改善关键人群的性健康和艾滋病毒结局。
Zotero 插件