在 21 个接受美国国际开发署资助的国家中，在 COVID-19 大流行的第一波期间，暴露前预防（PrEP）的采用和服务提供的调整。
Pre-exposure prophylaxis (PrEP) uptake and service delivery adaptations during the first wave of the COVID-19 pandemic in 21 PEPFAR-funded countries.
机构信息
Science Unit, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
出版信息
PLoS One. 2022 Apr 5;17(4):e0266280. doi: 10.1371/journal.pone.0266280. eCollection 2022.
BACKGROUND
Mitigation measures for the first wave of the COVID-19 pandemic and burden on health systems created challenges for pre-exposure prophylaxis (PrEP) service delivery. We examined PrEP uptake in PEPFAR programs before and after the start of the COVID-19 pandemic.
METHODS
We studied two PEPFAR program monitoring indicators, using routine Monitoring, Evaluation, Reporting (MER) indicators capturing uptake of PrEP (PrEP_NEW) and overall use of PrEP (PrEP_CURR). We also analyzed descriptive program narratives to understand successes and challenges field teams encountered after the start of the COVID-19 pandemic. To assess changes in coverage of PrEP across 21 countries, we calculated the "PrEP to need ratio" (PnR) using a published methodology. We defined the pre-COVID time period as April 1, 2019 -March 31, 2020 and the COVID time period as April 1, 2020 -March 31, 2021.
FINDINGS
The total number of persons who initiated PrEP increased by 157% from 233,250 in the pre-COVID-19 period compared with 599,935 in the COVID-19 period. All countries, except five, noted significant increases in PrEP uptake. PrEP uptake among adolescent girls and young women (AGYW) increased by 159% from 80,452 AGYW in the pre-COVID-19 period to 208,607 AGYW in the COVID-19 period. There were 77,430 key populations (KP) initiated on PrEP in the pre-COVID-19 period and 209,114 KP initiated in the COVID-19 period (a 170% increase). The PnR increased 214% in the COVID-19 period across all PEPFAR-supported countries. Adaptations, such as multi-month dispensing (MMD) of PrEP; virtual demand creation activities; decentralized, community-based and virtual service delivery, were implemented to maintain PrEP services.
CONCLUSIONS
PEPFAR programs continued to maintain and initiate new clients on PrEP despite the challenges posed by the COVID-19 pandemic. Adaptations such as MMD of PrEP and use of technology were vital in expanding service delivery and increasing PrEP coverage.
FUNDING
This project has been supported by the U.S. President's Emergency Plan for AIDS Relief.
背景
为应对 COVID-19 大流行的第一波疫情并减轻卫生系统负担，采取了缓解措施，这对暴露前预防（PrEP）服务的提供造成了挑战。我们研究了 COVID-19 大流行前后，PEPFAR 项目中 PrEP 的采用情况。
方法
我们使用常规监测、评估、报告（MER）指标，研究了 PEPFAR 项目中的两项监测指标，以了解 PrEP 的采用情况（PrEP_NEW）和 PrEP 的总体使用情况（PrEP_CURR）。我们还分析了描述性项目叙述，以了解大流行开始后现场团队所面临的成功和挑战。为评估 21 个国家 PrEP 覆盖率的变化，我们使用已发表的方法计算了“PrEP 需求比”（PnR）。我们将大流行前的时间定义为 2019 年 4 月 1 日至 2020 年 3 月 31 日，大流行期间的时间定义为 2020 年 4 月 1 日至 2021 年 3 月 31 日。
结果
与大流行前相比，PrEP 新启动人数增加了 157%，从 233250 人增至 599935 人。除五个国家外，所有国家的 PrEP 采用率均显著增加。青春期少女和年轻妇女（AGYW）的 PrEP 采用率从大流行前的 80452 名 AGYW 增加到了大流行期间的 208607 名 AGYW，增加了 159%。大流行前有 77430 名关键人群（KP）开始使用 PrEP，大流行期间有 209114 名 KP 开始使用（增加了 170%）。所有接受 PEPFAR 支持的国家，PrEP 的 PnR 在大流行期间增加了 214%。为维持 PrEP 服务，采取了多剂量预充型包装（MMD）的 PrEP、虚拟需求创造活动、分散式、基于社区和虚拟服务提供等调整措施。
结论
尽管 COVID-19 大流行带来了挑战，PEPFAR 项目仍继续为新老客户维持和启动 PrEP。PrEP 的 MMD 等调整措施和技术的使用对于扩大服务提供和增加 PrEP 覆盖率至关重要。
资金来源
本项目由美国艾滋病紧急救援计划提供支持。
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