Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Bill & Melinda Gates Foundation, Seattle, Washington, USA.
J Int AIDS Soc. 2024 Aug;27(8):e26341. doi: 10.1002/jia2.26341.
Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs.
We conducted a scoping review to elucidate factors influencing HCWs' use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post-exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes.
Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs' uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma.
Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs' PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs' PEP use.
Lessons from HCWs' experience in LMICs may inform understanding of PEP under-use among people in these settings with non-occupational exposures.
暴露后预防（PEP）是在 HIV 暴露后及时启动的一种有效的预防方法。然而，即使在有 PEP 政策和程序并可获得 PEP 药物的地点，医护人员（HCWs）的 PEP 使用率仍然很低。了解在看似最佳的情况下 PEP 使用不均衡的动态情况，对于更好地保护 HCWs 的健康和福祉非常重要。
我们进行了范围综述，以阐明影响 HCWs 在职业暴露后使用 PEP 的因素。我们使用 HIV、暴露后/暴露后预防、可接受性、医护人员以及价值观和偏好等术语，在 PubMed、PsychInfo 和 Google Scholar 上搜索了 2014 年至 2022 年发表的英文同行评议文献。对产生的 53 项研究进行了归纳性叙述性综述，确定了核心主题。
几乎所有（96%）研究都涉及不同类型的 HCWs 和非洲和亚洲的中低收入国家（LMICs）中的各种环境。确定的主题沿着 PEP 使用经验的轨迹排列：意识/知识；可接受性；可用性/可及性；采用/使用；坚持/完成。在所有研究中，HIV 预防 PEP 的意识很高，对药物方案和医疗机构政策的了解为中等至低等；PEP 的可接受性为中等至高等；PEP 的可感知可及性/可用性不一致，且因地理位置和环境而异；HCWs 对 PEP 的采用率较低，受到不知道如何报告暴露以及不知道 PEP 可用性的影响；PEP 方案的坚持/完成率为中等至低等，受到副作用和完成方案对避免血清转化不必要的信念的影响。HCWs 一直对 HIV 污名表示关注。
研究结果受到研究中使用的构建不一致以及对报告暴露事件缺乏明确性的限制。需要采取多层次的方法来解决个人、社会和结构障碍的相互作用，这些障碍会降低 HCWs 使用 PEP 的意愿。改进培训、事件报告、24 小时获得无污名 PEP 服务以及监测坚持/完成情况，对于优化 HCWs 使用 PEP 至关重要。
来自 LMICs 中 HCWs 经验的教训可能有助于了解这些环境中非职业暴露人群中 PEP 使用不足的原因。
