医学研究生对常规 HIV 筛查以及提供和转介暴露后预防和暴露前预防的态度和感知障碍。

Attitudes and Perceived Barriers to Routine HIV Screening and Provision and Linkage of Postexposure Prophylaxis and Pre-Exposure Prophylaxis Among Graduate Medical Trainees.

机构信息

Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.

New York-Presbyterian Hospital HIV Prevention Program, New York, New York, USA.

出版信息

AIDS Patient Care STDS. 2021 May;35(5):180-187. doi: 10.1089/apc.2021.0029. Epub 2021 Apr 23.

Abstract

New York City is the metropolitan area in the United States with the highest number of new HIV diagnoses nationwide. The End-The-Epidemic (EtE) initiative calls for identifying persons with HIV who remain undiagnosed, linking and retaining persons living with HIV to maximize viral suppression, and facilitate access to pre-exposure prophylaxis (PrEP) for patients at increased risk of HIV. HIV screening represents the first step to both the primary and secondary HIV prevention cascades. We conducted an online, anonymous, cross-sectional survey of residents at all stages of training within four residency programs at one institution in Northern Manhattan between August 2017 and August 2018. All internal medicine, emergency medicine, obstetrics and gynecology trainees, and pediatrics were invited to complete the survey via email. Of 298 eligible trainees, 142 (48%) completed the survey. Most trainees were aware of the HIV testing law and agreed that HIV testing was their responsibility, but few successfully screened most of their patients. Most trainees were not knowledgeable about non-occupational post-exposure prophylaxis (nPEP) or PrEP, but felt that it was important to provide these services across settings. Barriers to HIV, nPEP, and PrEP varied across specialties. Ending the HIV epidemic will require efforts across clinical specialties. In this survey from an EtE jurisdiction, most trainees felt that it is important to provide HIV prevention services in most settings; however, their knowledge and comfort with HIV prevention services other than testing were low. Barriers varied across specialties, and developing specialty-specific materials for trainees may be beneficial.

摘要

纽约市是美国拥有全国最多新 HIV 诊断病例的大都市地区。终结艾滋病(EtE)倡议呼吁发现未被诊断的 HIV 感染者,将 HIV 感染者与治疗机构联系起来并留住他们,以最大限度地提高病毒抑制率,并为感染 HIV 风险增加的患者提供暴露前预防(PrEP)。HIV 筛查是初级和二级 HIV 预防级联的第一步。我们在 2017 年 8 月至 2018 年 8 月期间,对位于纽约北部曼哈顿的一家机构的四个住院医师培训项目中处于各个培训阶段的住院医师进行了一项在线、匿名、横断面调查。所有内科、急诊医学、妇产科和儿科的住院医师都被邀请通过电子邮件完成调查。在 298 名符合条件的住院医师中,有 142 名(48%)完成了调查。大多数住院医师了解 HIV 检测法,并同意 HIV 检测是他们的责任,但很少有人能成功地对大多数患者进行筛查。大多数住院医师对非职业性暴露后预防(nPEP)或 PrEP 知之甚少,但认为在各种环境下提供这些服务很重要。HIV、nPEP 和 PrEP 方面的障碍因专业而异。要终结 HIV 疫情,需要各临床科室共同努力。在这个来自 EtE 管辖区的调查中,大多数住院医师认为在大多数环境下提供 HIV 预防服务很重要;然而,他们对除检测以外的 HIV 预防服务的知识和舒适度都较低。障碍因专业而异,为住院医师开发特定专业的材料可能会有所帮助。

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