Carroll Julie-Anne, Mullens Amy B, Warzywoda Sarah, Baker Philip R A, Stafford Meika, McMillan Faye, Manton Jacintha, Demant Daniel
School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia.
PLoS One. 2025 Feb 6;20(2):e0317669. doi: 10.1371/journal.pone.0317669. eCollection 2025.
A recent resurgence of bacterial sexually transmitted infections (STIs) is placing a major burden on high-risk populations, physicians, and the healthcare system. Treatment in the form of antibiotic pre-exposure prophylaxis (STI PrEP) is a potential solution. However, little is known about the acceptability and feasibility of this approach in high-risk populations.
A comprehensive search strategy was developed and executed in October 2024 across six databases adhering to PRISMA guidelines.
Eight studies met the inclusion criteria. These studies were all conducted in high-income countries, used various methods, and all focussed on sexual minority men. Findings consistently identified moderate to high levels of acceptability among GBMSM (54.3% - 67.5%). Factors such as engagement in perceived 'high risk' sexual encounters, and past diagnosis of STIs strengthened acceptability, while others (e.g., antimicrobial resistance concerns and stigma) act as barriers. Only one study included the perspectives of healthcare workers, indicating a moderate willingness to prescribe, which would increase under governing-body endorsement.
Overall, while there is some promise of STI PrEP acceptability among GBMSM, vast gaps in knowledge remain. Knowledge transfer and feasibility and, hence, the sustainability and capacity needed for the success of STI PrEP is yet to be examined and understood. However, for STI PrEP to be successfully adopted, it is essential not only to assess its acceptability and feasibility but also to focus on knowledge transfer. Knowledge transfer is a dynamic and iterative process, involving the synthesis, dissemination, exchange, and application of knowledge in an ethically sound manner. This process supports the improvement of health outcomes, strengthens healthcare systems, and ensures that healthcare interventions, such as STI PrEP, are effectively understood and implemented by both healthcare providers and at-risk populations. Similarly, the perspectives of populations beyond GBMSM have been omitted, and there is little understanding of the impact of their differing socio-cultural contexts around sex-related behaviour and Western pharmaceutical healthcare interventions on their acceptance and uptake.
Further research into acceptability, feasibility and knowledge transfer among diverse high-risk groups, healthcare professionals, and policymakers is necessary to create a strong foundation for implementing STI PrEP.
近期细菌性性传播感染（STIs）再度流行，给高危人群、医生及医疗系统带来了沉重负担。以抗生素暴露前预防（性传播感染暴露前预防，STI PrEP）形式进行的治疗是一种潜在的解决方案。然而，对于这种方法在高危人群中的可接受性和可行性知之甚少。
2024年10月，按照PRISMA指南，制定并执行了一项全面的检索策略，检索了六个数据库。
八项研究符合纳入标准。这些研究均在高收入国家开展，采用了多种方法，且均聚焦于男同性恋、双性恋及其他男男性行为者（GBMSM）。研究结果一致表明，GBMSM的接受程度为中度至高（54.3% - 67.5%）。参与被视为“高风险”性接触以及既往有性传播感染诊断等因素增强了接受度，而其他因素（如对抗菌素耐药性的担忧和污名化）则构成了障碍。只有一项研究纳入了医护人员的观点，表明其开具处方的意愿为中度，在管理机构认可的情况下这一意愿会增强。
总体而言，虽然GBMSM对性传播感染暴露前预防有一定的接受可能性，但知识方面仍存在巨大差距。知识转移以及可行性，进而性传播感染暴露前预防成功所需的可持续性和能力，仍有待研究和理解。然而，要成功采用性传播感染暴露前预防，不仅要评估其可接受性和可行性，还必须注重知识转移。知识转移是一个动态且反复的过程，涉及以符合道德规范的方式对知识进行综合、传播、交流和应用。这一过程有助于改善健康结果、加强医疗系统，并确保医疗干预措施（如性传播感染暴露前预防）能被医护人员和高危人群有效理解并实施。同样，GBMSM以外人群的观点被忽略了，对于他们不同的与性相关行为的社会文化背景以及西方药物医疗干预措施对其接受和采用的影响了解甚少。
有必要对不同高危群体、医护专业人员和政策制定者之间的可接受性、可行性和知识转移进行进一步研究，为实施性传播感染暴露前预防奠定坚实基础。
