FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
LVCT Health, Nairobi, Kenya.
Curr HIV/AIDS Rep. 2024 Oct;21(5):282-292. doi: 10.1007/s11904-024-00704-1. Epub 2024 Jul 24.
Despite the growing availability of oral PrEP, coverage remains suboptimal. Through the introduction of additional PrEP methods, including vaginal rings and long-acting injectable formulations, health systems globally are on the cusp of offering PrEP methods that vary by route of administration, efficacy, and frequency of use. With PrEP choice, it will be important to explore PrEP use patterns to better understand how the ability to choose and switch products affects coverage and continuation. In this review, we draw parallels with family planning (FP) by summarizing how method choice and product switching affected contraceptive coverage globally, synthesize what is known about PrEP product switching, and outline evidence gaps to help guide future research on PrEP switching in the context of choice.
Decades of research in FP has demonstrated that product switching is common and can lead to more satisfaction and increases in contraceptive use. While research on PrEP product switching is nascent, findings suggest switching is common, and that providing more than one PrEP option can increase coverage. Key evidence gaps include understanding product switching in the context of full versus constrained choice, switching in the context of temporary need, and developing interventions that promote product switching for those who could benefit. Providing choice and allowing people to start, stop, and switch products according to their needs and desires is a core component of a rights-based approach to HIV prevention. More research is needed to better understand what drives use patterns, including switching, and how to leverage choice to improve coverage. Standard definitions -some of which have been proposed in this review-are needed to inform comparable measurement. Finally, there is a need to holistically frame PrEP use to acknowledge changes in need over the life course, thus making method switching a standard part of HIV prevention.
尽管口服暴露前预防（PrEP）的可及性不断增加，但覆盖率仍然不理想。随着包括阴道环和长效注射制剂在内的其他 PrEP 方法的引入，全球卫生系统即将提供不同给药途径、疗效和使用频率的 PrEP 方法。随着 PrEP 选择的增加，探索 PrEP 使用模式以更好地了解选择和切换产品的能力如何影响覆盖率和持续时间将非常重要。在这篇综述中，我们通过总结方法选择和产品切换如何影响全球避孕覆盖率，来与计划生育（FP）进行类比，综合了解关于 PrEP 产品切换的知识，并概述证据空白，以帮助指导未来在选择背景下进行 PrEP 切换的研究。
FP 领域数十年的研究表明，产品切换很常见，并且可以提高避孕措施的满意度和使用率。尽管关于 PrEP 产品切换的研究还处于起步阶段，但研究结果表明切换很常见，并且提供多种 PrEP 选择可以提高覆盖率。关键的证据空白包括在充分选择和有限选择的背景下理解产品切换、在临时需求的背景下切换，以及为那些可能受益的人开发促进产品切换的干预措施。提供选择并允许人们根据自己的需求和愿望开始、停止和切换产品，是基于权利的艾滋病毒预防方法的核心组成部分。需要进行更多的研究，以更好地了解是什么驱动了使用模式，包括切换，以及如何利用选择来提高覆盖率。需要有一些标准定义——其中一些在本综述中已经提出——来提供可比的衡量标准。最后，需要全面看待 PrEP 的使用，以承认一生中需求的变化，从而使方法切换成为艾滋病毒预防的一个标准部分。
