COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Jhpiego, Washington, DC, United States.
JMIR Public Health Surveill. 2022 Jun 7;8(6):e37479. doi: 10.2196/37479.
BACKGROUND: The novel coronavirus disease COVID-19 caused by SARS-CoV-2 threatens to disrupt global progress toward HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. OBJECTIVE: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. The aim of this study was to summarize the related literature to highlight adaptations that could address potential COVID-19-related service interruptions. METHODS: We performed a systematic review and searched six databases, OVID/Medline, Scopus, Cochrane Library, CINAHL, PsycINFO, and Embase, for studies published between January 1, 2010, and October 26, 2021, related to recent technology-based interventions for virtual service delivery. Search terms included "telemedicine," "telehealth," "mobile health," "eHealth," "mHealth," "telecommunication," "social media," "mobile device," and "internet," among others. Of the 6685 abstracts identified, 1259 focused on HIV virtual service delivery, 120 of which were relevant for HIV prevention efforts; 48 pertained to pre-exposure prophylaxis (PrEP) and 19 of these focused on evaluations of interventions for the virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies' methodological approaches and outcomes; thus, a meta-analysis was not performed. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. RESULTS: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone apps such as iText (50% [95% CI 16%-71%] reduction in discontinuation of PrEP) and PrEPmate (OR 2.62, 95% CI 1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as Extension for Community Healthcare Outcomes (ECHO). We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications for monitoring. CONCLUSIONS: Innovations in the virtual service provision of PrEP occurred before COVID-19 but have new relevance during the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible health care platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services, which can be leveraged to facilitate COVID-19 pandemic control now and for future responses.
背景:由 SARS-CoV-2 引起的新型冠状病毒病(COVID-19)有可能破坏全球在艾滋病病毒(HIV)防控方面取得的进展。当前存在利用正在进行的公共卫生应对措施减轻 COVID-19 对 HIV 服务影响的机会,并且为提供新型护理服务的方法可能有助于解决这两种流行病。
目的:随着 COVID-19 大流行的持续,需要采用新的方法来维持全面的 HIV 预防服务的提供。本研究旨在总结相关文献,以突出可能解决与 COVID-19 相关的服务中断的适应措施。
方法:我们进行了系统评价,检索了六个数据库,包括 OVID/Medline、Scopus、Cochrane 图书馆、CINAHL、PsycINFO 和 Embase,以获取 2010 年 1 月 1 日至 2021 年 10 月 26 日期间发表的与最近基于技术的虚拟服务提供相关的干预措施的研究。搜索词包括“远程医疗”、“远程保健”、“移动医疗”、“电子医疗”、“移动医疗”、“电信”、“社交媒体”、“移动设备”和“互联网”等。在确定的 6685 篇摘要中,有 1259 篇专注于 HIV 虚拟服务的提供,其中 120 篇与 HIV 预防工作相关;48 篇涉及暴露前预防(PrEP),其中 19 篇重点介绍了 PrEP 虚拟服务提供的干预措施。在确定的 16 篇系统评价中,有 3 篇专门针对 PrEP。对所有 35 篇论文进行了评估,以了解其疗效、可行性和/或可接受性的结果。研究方法和结果存在局限性;因此,未进行荟萃分析。我们考虑了我们审查中发现的循证干预措施,并为 HIV 预防干预措施制定了虚拟服务提供模型。我们还考虑了如何利用这个平台来预防 COVID-19 和进行护理。
结果:我们总结了 19 项关于 PrEP 虚拟服务提供的研究和 16 项相关综述。为 PrEP 服务提供提供有效、可行和/或可接受的基于技术的干预措施示例包括:使用短信、互联网和智能手机应用程序,如 iText(PrEP 停药率降低 50% [95%CI 16%-71%])和 PrEPmate(OR 2.62,95%CI 1.24-5.54);用于虚拟就诊的远程保健和电子保健平台,如 PrEPTECH 和 IowaTelePrEP;以及用于培训保健工作者的平台,如社区卫生保健成果扩展(Extension for Community Healthcare Outcomes,ECHO)。我们建议为 PrEP 提供虚拟服务提供模型,可以利用互联网和社交媒体来创造需求,利用社区自我检测,利用远程保健平台进行风险评估和后续护理,利用支持小组和依从性/预约提醒应用程序,以及利用监测应用程序。
结论:在 COVID-19 大流行之前,PrEP 的虚拟服务提供方面的创新已经出现,但在 COVID-19 大流行期间具有新的相关性。我们描述的创新可以通过接触传统上难以接触的人群、减少污名化和创建更便于获得的医疗保健平台,在 COVID-19 大流行期间以及从长远来看加强 HIV 预防服务的提供。这些虚拟服务提供平台可以减轻 COVID-19 大流行对 HIV 服务的影响,也可以利用这些平台来促进 COVID-19 大流行的控制以及未来的应对措施。
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