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融合去实施与实施以促进通用暴露前预防指南的采用:决定因素、策略和结果

Blending De-implementation and Implementation to Promote Adoption of Universal PrEP Guidelines: Determinants, Strategies, and Outcomes.

作者信息

Jaramillo Jahn, Bartholomew Tyler S, Harkness Audrey

机构信息

Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.

School of Nursing and Health Studies, University of Miami, Miami, FL, USA.

出版信息

Crit Public Health. 2025;35(1). doi: 10.1080/09581596.2025.2498714. Epub 2025 Apr 30.


DOI:10.1080/09581596.2025.2498714
PMID:40585510
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12199270/
Abstract

In 2021, the Centers for Disease Control and Prevention (CDC) proposed updated clinical practice guidelines for Pre-Exposure Prophylaxis (PrEP), marking a significant shift from risk-based screening to discussing PrEP with all sexually active adults. To ensure widespread adoption of new guidelines, this commentary posits that intentional de-implementation of the previous CDC guidelines is necessary to facilitate the adoption, implementation, and sustainment of new guidelines. Based on a review of the literature, the authors leveraged implementation science frameworks (i.e., CFIR, ERIC taxonomy, and RE-AIM) to map theoretical determinants, corresponding strategies, and outcomes in the context of de-implementing previous CDC guidelines for PrEP and simultaneously implementing the new guidelines. Potential barriers identified included resource constraints, staff capability, and structural characteristics of organizations that may impede de-implementation efforts. Potential facilitators included provider motivation and incentive systems that encourage providers to discuss PrEP with sexually active clients. Strategies like normalizing PrEP education and services, workflow redesign, and task-shifting could tackle workforce challenges. These strategies could aid in phasing out old guidelines, implementing new guidelines, increasing PrEP referrals, and reducing HIV incidence. Phasing out previous PrEP guidelines demands intentional (de-)implementation to enhance universal HIV prevention efforts and advance national plans for Ending the HIV Epidemic.

摘要

2021年,美国疾病控制与预防中心(CDC)提出了暴露前预防(PrEP)的最新临床实践指南,标志着从基于风险的筛查到与所有性活跃成年人讨论PrEP的重大转变。为确保新指南得到广泛采用,本评论认为,有意废除先前的CDC指南对于促进新指南的采用、实施和持续实施是必要的。基于对文献的回顾,作者利用实施科学框架(即CFIR、ERIC分类法和RE-AIM)来梳理在废除先前的CDC PrEP指南并同时实施新指南的背景下的理论决定因素、相应策略和结果。确定的潜在障碍包括资源限制、工作人员能力以及可能阻碍废除工作的组织结构特征。潜在的促进因素包括提供者的积极性和鼓励提供者与性活跃客户讨论PrEP的激励系统。将PrEP教育和服务常态化、重新设计工作流程以及任务转移等策略可以应对劳动力方面的挑战。这些策略有助于逐步淘汰旧指南、实施新指南、增加PrEP转诊并降低艾滋病毒发病率。逐步淘汰先前的PrEP指南需要有意的(去)实施,以加强普遍的艾滋病毒预防工作并推进终结艾滋病毒流行的国家计划。

相似文献

[1]
Blending De-implementation and Implementation to Promote Adoption of Universal PrEP Guidelines: Determinants, Strategies, and Outcomes.

Crit Public Health. 2025

[2]
Improving HIV Prevention Among Heterosexual Men Seeking Sexually Transmitted Infection Services in Malawi: Protocol for a Type I Effectiveness-Implementation Hybrid Randomized Controlled Trial of Systems Navigator-Delivered Integrated Prevention Package (HPTN 112-NJIRA Study).

JMIR Res Protoc. 2025-6-18

[3]
Health Care Providers' Views on Clinic Infrastructure and Practice Models That May Facilitate HIV Preexposure Prophylaxis (PrEP) Prescribing: A Qualitative Meta-Synthesis.

Health Promot Pract. 2022-11

[4]
Facilitators and Barriers to Equitable Implementation of Telehealth PrEP Delivery: A Qualitative Descriptive Study of Program Staff and Stakeholders.

Health Promot Pract. 2025-6-19

[5]
Evidence and implication of interventions across various socioecological levels to address pre-exposure prophylaxis uptake and adherence among men who have sex with men in the United States: a systematic review.

AIDS Res Ther. 2022-6-26

[6]
Missed opportunities for sexually transmitted infections testing for HIV pre-exposure prophylaxis users: a systematic review.

J Int AIDS Soc. 2021-2

[7]
Addressing Barriers to Implementing and Scaling PrEP in Carceral Settings: Applying Insights From Implementation Science.

J Acquir Immune Defic Syndr. 2025-1-1

[8]
Implementation strategies for WHO guidelines to prevent, detect, and treat postpartum hemorrhage.

Cochrane Database Syst Rev. 2025-2-26

[9]
Development of a Novel Shared Care Intervention to Address Obstructive Sleep Apnea in Rural West Virginia.

Ann Am Thorac Soc. 2025-3-24

[10]
Enhancing provider adoption of patient-reported outcome measures (PROMs) through implementation science: insights from two international workshops.

J Patient Rep Outcomes. 2025-7-1

本文引用的文献

[1]
Responding to the HIV Health Literacy Needs of Clients in Substance Use Treatment: The Role of Universal PrEP Education in HIV Health and Prevention.

Int J Environ Res Public Health. 2023-10-7

[2]
Retrospective audit of a convenience cohort of individuals on HIV pre-exposure prophylaxis in Alberta, Canada.

J Assoc Med Microbiol Infect Dis Can. 2022-11-29

[3]
Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity.

Implement Res Pract. 2021-11-26

[4]
Theories, models, and frameworks for de-implementation of low-value care: A scoping review of the literature.

Implement Res Pract. 2020-9-18

[5]
Ending the HIV epidemic PrEP equity recommendations from a rapid ethnographic assessment of multilevel PrEP use determinants among young Black gay and bisexual men in Atlanta, GA.

PLoS One. 2023

[6]
Provider perspectives on clinical decision support to improve HIV prevention in pediatric primary care: a multiple methods study.

Implement Sci Commun. 2023-2-21

[7]
Risk-based versus universal PrEP delivery during pregnancy: a cluster randomized trial in Western Kenya from 2018 to 2019.

J Int AIDS Soc. 2023-2

[8]
An update on expanding HIV preexposure prophylaxis.

JAAPA. 2023-2-1

[9]
Missed Opportunities When We Focus only on Risk: Using the Concerns Based Conversation Starter to Identify Potential PrEP Candidates.

AIDS Behav. 2023-8

[10]
Readiness to Provide Oral and Injectable PrEP for Sexual and Gender Minority Youth Among Healthcare Providers and Clinics in the U.S. Northeast.

J Adolesc Health. 2023-5

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