Department of Pharmacy, University of Washington, Seattle, Washington, USA.
Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
J Int AIDS Soc. 2022 Oct;25(10):e26027. doi: 10.1002/jia2.26027.
INTRODUCTION: Private pharmacies are an understudied setting for differentiated delivery of HIV services that may address barriers to clinic-delivered services, such as stigma and long wait times. To understand the potential for pharmacy-delivered HIV services in sub-Saharan Africa, we conducted a scoping review of the published and grey literature. METHODS: Using a modified Cochrane approach, we searched electronic databases through March 2022 and HIV conference abstracts in the past 5 years for studies that: (1) focused on the delivery of HIV testing, antiretroviral therapy (ART) and/or pre-exposure prophylaxis (PrEP) at private pharmacies in sub-Saharan Africa; (2) reported on effectiveness outcomes (e.g. HIV incidence) or implementation outcomes, specifically feasibility and/or acceptability; and (3) were published in English. Two authors identified studies and extracted data on study setting, population, design, outcomes and findings by HIV service type. RESULTS AND DISCUSSION: Our search identified 1646 studies. After screening and review, we included 28 studies: seven on HIV testing, nine on ART delivery and 12 on PrEP delivery. Most studies (n = 16) were conducted in East Africa, primarily in Kenya. Only two studies evaluated effectiveness outcomes; the majority (n = 26) reported on feasibility and/or acceptability outcomes. The limited effectiveness data (n = 2 randomized trials) suggest that pharmacy-delivered HIV services can increase demand and result in comparable clinical outcomes (e.g. viral load suppression) to standard-of-care clinic-based models. Studies assessing implementation outcomes found actual and hypothetical models of pharmacy-delivered HIV services to be largely feasible (e.g. high initiation and continuation) and acceptable (e.g. preferable to facility-based models and high willingness to pay/provide) among stakeholders, providers and clients. Potential barriers to implementation included a lack of pharmacy provider training on HIV service delivery, costs to clients and providers, and perceived low quality of care. CONCLUSIONS: The current evidence suggests that pharmacy-delivered HIV services may be feasible to implement and acceptable to clients and providers in parts of sub-Saharan Africa. However, limited evidence outside East Africa exists, as does limited evidence on the effectiveness of and costs associated with pharmacy-delivered HIV services. More research of this nature is needed to inform the scale-up of this new differentiated service delivery model throughout the region.
引言:私人药店是一个研究不足的领域,在那里可以提供差异化的艾滋病毒服务,以解决诊所提供服务的障碍,如污名和长时间等待。为了了解在撒哈拉以南非洲地区提供药店艾滋病毒服务的潜力,我们对已发表和灰色文献进行了范围综述。
方法:我们使用改良的 Cochrane 方法,通过 2022 年 3 月前的电子数据库和过去 5 年的艾滋病毒会议摘要进行搜索,以确定:(1)在撒哈拉以南非洲的私人药店提供艾滋病毒检测、抗逆转录病毒疗法 (ART) 和/或暴露前预防 (PrEP) 的研究;(2)报告有效性结果(例如艾滋病毒发病率)或实施结果,特别是可行性和/或可接受性;(3)用英文发表。两位作者确定了研究,并按艾滋病毒服务类型提取了关于研究背景、人群、设计、结果和发现的信息。
结果和讨论:我们的搜索确定了 1646 项研究。经过筛选和审查,我们纳入了 28 项研究:7 项关于艾滋病毒检测,9 项关于 ART 交付,12 项关于 PrEP 交付。大多数研究(n = 16)在东非进行,主要在肯尼亚。只有两项研究评估了有效性结果;大多数(n = 26)报告了可行性和/或可接受性结果。有限的有效性数据(n = 2 项随机试验)表明,药店提供的艾滋病毒服务可以增加需求,并产生与基于标准护理诊所的模式相当的临床结果(例如病毒载量抑制)。评估实施结果的研究发现,实际和假设的药店提供的艾滋病毒服务模型在利益相关者、提供者和客户中基本上是可行的(例如,高启动和持续)和可接受的(例如,优于基于机构的模型,并且高意愿支付/提供)。实施的潜在障碍包括艾滋病毒服务提供方面缺乏药店提供者培训、客户和提供者的成本以及对护理质量的感知低。
结论:目前的证据表明,在撒哈拉以南非洲的部分地区,药店提供的艾滋病毒服务可能具有可行性,并且可以被客户和提供者接受。然而,除了东非以外,这方面的证据有限,并且关于药店提供的艾滋病毒服务的效果和相关成本的证据也有限。需要进行更多此类性质的研究,以便为该地区的这种新的差异化服务提供模型的扩展提供信息。
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