Allan-Blitz Lao-Tzu, Mayer Kenneth H
Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Open Forum Infect Dis. 2024 Jun 15;11(8):ofae332. doi: 10.1093/ofid/ofae332. eCollection 2024 Aug.
Postexposure prophylaxis (PEP) is an important tool for preventing HIV infection but remains underutilized. In this narrative review, we aim to summarize the frequency of missed opportunities for prescribing PEP among studies from around the world, discuss the complexities of the challenges facing PEP provision, and describe possible solutions. We identified 20 studies published in the last 10 years among 43 832 individuals, of whom an estimated 41 477 were eligible for PEP. Of those eligible for PEP, PEP was prescribed among 27 705 (66.8%). There was a significant difference in PEP prescriptions in acute compared with non-acute care settings (63.5% vs 94.5%; < .001). Emergent themes contributing to PEP underutilization included lack of provider and patient awareness, reduced PEP acceptability, HIV stigma and homophobia, lack of access (either to care or to medication), and stigmatizing policies. Each of those issues should be the focus of future PEP implementation efforts.
暴露后预防（PEP）是预防HIV感染的一项重要手段，但目前仍未得到充分利用。在这篇叙述性综述中，我们旨在总结全球范围内各项研究中错过开具PEP机会的频率，探讨提供PEP所面临挑战的复杂性，并描述可能的解决方案。我们在过去10年发表的研究中筛选出20项，涉及43832人，其中估计有41477人符合PEP用药条件。在符合PEP用药条件的人群中，有27705人（66.8%）开具了PEP。与非急诊护理环境相比，急诊护理环境中的PEP处方率存在显著差异（63.5%对94.5%；P<0.001）。导致PEP未得到充分利用的新出现的主题包括医护人员和患者缺乏认识、PEP可接受性降低、HIV污名化和恐同症、缺乏可及性（无论是医疗服务还是药物）以及污名化政策。这些问题均应成为未来PEP实施工作的重点。
