Danila R N
Minnesota Department of Health, Acute Disease Epidemiology Section, Minneapolis 55440-9441, USA.
Am J Med. 1997 May 19;102(5B):98-101. doi: 10.1016/s0002-9343(97)00074-0.
Public health agencies across the country uniformly retain three core functions, as identified in a 1988 Institute of Medicine report: assessment, assurance, and planning and policy development. The conduct of these functions will influence the ways the Public Health Service recommendations for postexposure prophylaxis are implemented locally. State, territorial, and local health departments play a key role in the monitoring and prevention of occupationally acquired human immunodeficiency virus (HIV) infections. Through assessment, public health agencies often are responsible for investigating healthcare workers who apparently have contracted HIV infection through an occupational exposure. In their function of providing assurance, public health agencies disseminate the national recommendations and may provide expert consultation taking into consideration local conditions. Specific healthcare worker exposure situations may pose complex medical and legal challenges best handled by public health agencies. In their role of providing policy development, public health agencies may convene an expert panel to review local data that affect postexposure prophylaxis, such as antiretroviral drug resistance and drug availability. The recommendations may result in legislative action in the form of mandatory testing of patients or other groups, and public health agencies must be wary of such attempts that are of unproven efficacy. Public health agencies nationwide must see that exposed healthcare workers and the clinicians counseling them are adequately informed about the risks of HIV transmission and the options available for prophylaxis.
正如1988年医学研究所的一份报告所指出的，全国的公共卫生机构统一保留三项核心职能：评估、保障以及规划与政策制定。这些职能的实施方式将影响地方层面实施公共卫生服务暴露后预防建议的方式。州、地区和地方卫生部门在监测和预防职业性获得性人类免疫缺陷病毒（HIV）感染方面发挥着关键作用。通过评估，公共卫生机构通常负责调查那些显然因职业暴露而感染HIV的医护人员。在履行保障职能时，公共卫生机构传播国家建议，并可能根据当地情况提供专家咨询。特定的医护人员暴露情况可能带来复杂的医学和法律挑战，而公共卫生机构最适合处理这些挑战。在履行政策制定职能时，公共卫生机构可能会召集一个专家小组，以审查影响暴露后预防的当地数据，如抗逆转录病毒药物耐药性和药物可及性。这些建议可能会导致以对患者或其他群体进行强制检测的形式出现立法行动，而公共卫生机构必须警惕此类未经证实疗效的尝试。全国的公共卫生机构必须确保，让暴露的医护人员以及为他们提供咨询的临床医生充分了解HIV传播的风险以及可用的预防选择。
