Jaramillo Jahn, Bartholomew Tyler S, Harkness Audrey
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.
Crit Public Health. 2025;35(1). doi: 10.1080/09581596.2025.2498714. Epub 2025 Apr 30.
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.
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。
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