New York City Department of Health and Mental Hygiene, Queens, New York.
New York City Department of Health and Mental Hygiene, Queens, New York.
Am J Prev Med. 2021 Nov;61(5 Suppl 1):S98-S107. doi: 10.1016/j.amepre.2021.05.032.
Equitable access to HIV pre- and postexposure prophylaxis for women is essential to ending the HIV epidemic. Providers' lack of knowledge and comfort in discussing and prescribing pre-exposure prophylaxis to women persist as barriers.
From May to November 2019, the New York City Health Department conducted its first public health detailing campaigns among women's healthcare providers to promote pre- and postexposure prophylaxis and the associated best practices. Over 2 campaigns (10 weeks each), trained Health Department representatives visited providers for 1-on-1 visits at select practices to promote key messages. Representatives distributed an Action Kit that addressed knowledge gaps and practice needs on providing pre-exposure prophylaxis and postexposure prophylaxis to cisgender and transgender women. Providers completed an assessment at the beginning of initial and follow-up visits, used to compare responses across visits. Statistically significant changes were evaluated by generalized linear models of bivariate outcomes, adjusted for nonindependence of providers at the same practice.
Representatives visited 1,348 providers specializing in primary care (47%), women's health (30%), adolescent health (7%), infectious disease (4%), and other (12%) at 860 sites; 1,097 providers received initial and follow-up visits. Provider report of ever prescribing pre-exposure prophylaxis increased by 12% (n=119 providers); increases were reported in measures of taking sexual history, asking about partners' HIV status, providing postexposure prophylaxis, recognizing pre-exposure prophylaxis's effectiveness, and discussing and referring for pre-exposure prophylaxis.
After public health detailing, women's healthcare providers report increased adoption of recommended practices that promote pre- and postexposure prophylaxis uptake and sexual wellness among women. Detailing may be adaptable to other regions and contexts to reach providers.
为了终结艾滋病疫情，确保女性能够公平地获得艾滋病毒预防前和预防后治疗至关重要。但提供者在讨论和开处预防前用药时缺乏知识和信心，这仍然是一个障碍。
2019 年 5 月至 11 月，纽约市卫生局针对女性医疗服务提供者开展了首次公共卫生宣传活动，以推广预防前和预防后治疗以及相关的最佳实践。在两次活动（每次持续 10 周）中，经过培训的卫生局代表前往选定诊所，与提供者进行一对一访问，以宣传关键信息。代表们分发了一个行动工具包，其中解决了为顺性别和跨性别女性提供预防前和预防后治疗方面的知识差距和实践需求。提供者在初次和后续访问开始时完成评估，用于比较访问期间的反应。通过二元结果的广义线性模型评估统计学上显著的变化，并针对同一实践中的提供者的非独立性进行了调整。
代表们访问了 860 个地点的 1348 名专门从事初级保健（47%）、妇女保健（30%）、青少年保健（7%）、传染病（4%）和其他（12%）的提供者；1097 名提供者接受了初次和后续访问。报告曾开预防前用药的提供者增加了 12%（119 名提供者）；在采取性病史、询问伴侣艾滋病毒状况、提供预防后治疗、认识预防前用药的有效性、讨论和转介预防前用药等方面的措施也有增加。
在公共卫生宣传之后，女性医疗服务提供者报告称，更多地采用了推荐的实践，这些实践促进了女性对预防前和预防后治疗的接受程度，并促进了她们的性健康。详细宣传可能适用于其他地区和背景，以覆盖更多的提供者。
