Are We Prepped for Preexposure Prophylaxis (PrEP)? Provider Opinions on the Real-World Use of PrEP in the United States and Canada
Are We Prepped for Preexposure Prophylaxis (PrEP)? Provider Opinions on the Real-World Use of PrEP in the United States and Canada
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DOI：
10.1093/cid/cit796
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发表时间：
2014-03-01
影响因子：
11.8
通讯作者：
Polgreen, Philip M.
中科院分区：
文献类型：
--
作者：
Karris, Maile Y.;Beekmann, Susan E.;Polgreen, Philip M.
背景富马酸替诺福韦酯和恩曲他滨（Truvada）的暴露前预防（PrEP）在安慰剂对照的临床试验中表现出疗效，这些试验涉及男性同性恋者、高风险异性恋者、血清不一致夫妇和静脉注射吸毒者。为了帮助在现实世界中提供PrEP，疾病控制和预防中心（CDC）已经发布了PrEP使用的指导文件。通过新兴感染网络（EIN），对成年传染病医生的意见和PrEP的现行做法进行了调查。地理信息系统分析被用来绘制出整个美国的供应商的反应。在全国1175名EIN成员中，有573人（48.8%）回答了调查。大多数临床医生支持PrEP，但只有9%的人实际提供了PrEP。尽管有CDC的指导，PrEP实践是可变的，临床医生报告了许多现实世界的供应障碍。美国和加拿大的大多数成年传染病医生支持PrEP，但尽管存在CDC指导文件，但意见和实践存在巨大差异。真实世界PrEP的成功可能需要多方面的计划来解决其提供的障碍，并将协助制定真实世界PrEP的综合指南。
Background. Preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine (Truvada) has demonstrated efficacy in placebo-controlled clinical trials involving men who have sex with men, high-risk heterosexuals, serodiscordant couples, and intravenous drug users. To assist in the real-world provision of PrEP, the Centers for Disease Control and Prevention (CDC) has released guidance documents for PrEP use.Methods. Adult infectious disease physicians were surveyed about their opinions and current practices of PrEP through the Emerging Infections Network (EIN). Geographic information systems analysis was used to map out provider responses across the United States.Results. Of 1175 EIN members across the country, 573 (48.8%) responded to the survey. A majority of clinicians supported PrEP but only 9% had actually provided it. Despite CDC guidance, PrEP practices were variable and clinicians reported many barriers to its real-world provision.Conclusions. The majority of adult infectious disease physicians across the United States and Canada support PrEP but have vast differences of opinion and practice, despite the existence of CDC guidance documents. The success of real-world PrEP will likely require multifaceted programs addressing barriers to its provision and will be assisted with the development of comprehensive guidelines for real-world PrEP.