Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
MSMR. 2024 Oct 20;31(10):11-16.
Use of HIV pre-exposure prophylaxis (PrEP) among U.S. military service members at high risk for HIV infection remains suboptimal, resulting in preventable new HIV infections and decreased medical readiness among service members. PrEP coverage should be increased to the greatest extent possible to prevent HIV infection and support the Military Health System (MHS) quadruple aim. This policy analysis employed the Centers for Disease Control and Prevention (CDC)'s Policy Analytical Framework to develop several policy options based upon the evidence summary and interventions described. Evaluation criteria based on the CDC's Policy Analytical Framework incorporated all elements of the Military Health System (MHS)'s quadruple aim, including impact on population health and readiness, impact on the experience of care, and value in terms of cost-effectiveness. An additional criterion of feasibility was also added to account for cultural, societal, and political factors influencing this policy decision. This policy analysis suggests that HIV PrEP coverage in the MHS remains suboptimal, while several available interventions could result in substantial increases in PrEP coverage that would, in turn, result in further reductions in new service member HIV infections and increased medical readiness.
在美国，感染艾滋病毒风险较高的军人对艾滋病毒暴露前预防（PrEP）的使用仍不理想，导致新的艾滋病毒感染可预防，军人的医疗准备状态下降。应尽可能扩大 PrEP 的覆盖面，以预防艾滋病毒感染，并支持军事卫生系统（MHS）的四重目标。本政策分析采用疾病预防控制中心（CDC）的政策分析框架，根据证据摘要和描述的干预措施制定了若干政策方案。基于疾病预防控制中心政策分析框架的评估标准纳入了军事卫生系统（MHS）四重目标的所有要素，包括对人群健康和准备状态的影响、对护理体验的影响以及成本效益方面的价值。还增加了一个可行性标准，以考虑影响这一政策决策的文化、社会和政治因素。这项政策分析表明，MHS 的艾滋病毒预防用药覆盖率仍不理想，而一些现有的干预措施可能会大大增加预防用药的覆盖率，从而进一步减少新入伍军人的艾滋病毒感染，并提高医疗准备状态。
