Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.
Evandro Chagas National Institute of Infectious Diseases-Fiocruz, Rio de Janeiro, Brazil.
J Int AIDS Soc. 2023 Jul;26 Suppl 2(Suppl 2):e26103. doi: 10.1002/jia2.26103.
With recent approvals of long-acting (LA) HIV pre-exposure prophylaxis (PrEP) in the form of injectable cabotegravir and the dapivirine ring, programmes need to consider how to optimize the delivery of PrEP methods, including by leveraging lessons from the past decade of oral PrEP delivery.
Framed around differentiated service delivery building blocks, the major considerations for the delivery of LA PrEP are how to reach the populations who would most benefit from PrEP, where to locate PrEP services, how to reduce the user burden of accessing and continuing with PrEP, and how to integrate PrEP with other services. Demand creation for LA PrEP and education about new LA PrEP options should be co-developed with communities and be positively framed. Client-facing clinical decision support tools provide information about HIV prevention and PrEP options in non-technical ways and can support their informed decision-making about PrEP. Training for providers is needed to increase their ability to ask about sexual and drug use behaviours in a non-judgmental and comfortable manner as part of risk assessment, discuss harm reduction strategies and counsel about available PrEP options that fit clients' circumstances and needs. PrEP adherence support should include supportive counselling and be tailored to address an individual's particular barriers and needs. Reminders through text messaging or calls can foster PrEP persistence, given the narrow the window around dosing for injectable cabotegravir. Strategies are needed to expand PrEP delivery options, including telePrEP, pharmacy-based PrEP, key population-led services and mobile venues. Integrated delivery models are needed which include sexually transmitted infection testing and treatment, contraception for cis-women not desiring to become pregnant, PrEP for pregnant women in high HIV prevalence settings, and gender-affirming hormones and support for transgender persons.
The outcome of expanding PrEP options through LA PrEP formulations is to increase PrEP coverage, adherence, persistence and effectiveness by offering a choice of PrEP that meets the needs of persons who would benefit from PrEP. The lessons learned from the delivery of oral PrEP about demand creation, informed client decision-making, provider training, adherence support and service delivery model are relevant to the delivery of LA PrEP and integration with other services.
随着长效（LA）HIV 暴露前预防（PrEP）药物注射用卡替拉韦和阴道避孕环的相继获批，各项目需要考虑如何优化 PrEP 方法的提供，包括借鉴过去十年口服 PrEP 提供方面的经验教训。
围绕差异化服务提供的组成部分，LA PrEP 提供的主要考虑因素包括如何接触最能从 PrEP 中受益的人群、在何处提供 PrEP 服务、如何降低获得和继续使用 PrEP 的用户负担，以及如何将 PrEP 与其他服务整合。LA PrEP 的需求创造和新 LA PrEP 选择的教育应与社区共同制定，并以积极的方式呈现。面向客户的临床决策支持工具以非技术性的方式提供有关 HIV 预防和 PrEP 选择的信息，可支持他们在知情的情况下做出有关 PrEP 的决策。需要对提供者进行培训，以提高他们在风险评估中以非评判和舒适的方式询问性行为和药物使用行为的能力，讨论减少伤害策略，并提供适合客户情况和需求的可用 PrEP 选择的咨询。PrEP 依从性支持应包括支持性咨询，并根据个人的特定障碍和需求进行调整。鉴于注射用卡替拉韦的剂量窗口较窄，通过短信或电话提醒可以促进 PrEP 的持续使用。需要扩大 PrEP 提供选择的策略，包括远程 PrEP、基于药房的 PrEP、重点人群主导的服务和流动场所。需要采用综合提供模式，包括性传播感染检测和治疗、不希望怀孕的顺性别女性的避孕措施、高 HIV 流行地区孕妇的 PrEP 以及跨性别者的性别肯定激素和支持。
通过 LA PrEP 制剂扩大 PrEP 选择的结果是通过提供满足可能从 PrEP 中受益的人群需求的 PrEP 选择，来提高 PrEP 的覆盖率、依从性、持续性和效果。从口服 PrEP 提供方面获得的关于需求创造、知情客户决策、提供者培训、依从性支持和服务提供模式的经验教训与 LA PrEP 的提供和与其他服务的整合相关。
