Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries.
Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries.
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DOI：
10.1097/qad.0000000000001627
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发表时间：
2017-10-23
期刊：
影响因子：
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通讯作者：
Mayer KH
中科院分区：
文献类型：
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作者：
Hoornenborg E;Krakower DS;Prins M;Mayer KH
暴露前预防（PrEP）是一种有效且未得到充分利用的艾滋病毒预防工具。在本文中，我们回顾了关于在早期采用国家中为男男性行为者和变性人实施PrEP的知识状况。我们专注于实施PrEP在示范项目和临床护理，并描述了PrEP的可用性和吸收的状态。我们报告了在现实环境中识别适当PrEP候选人的方法以及临床监测的最佳实践。这包括根据安全性数据，排除PrEP启动前未确诊的HIV感染和肾功能的纵向测量。由于坚持是调节PrEP有效性的主要因素，我们讨论了有效的坚持支持干预措施。此外，我们还审查了使用PrEP进行风险补偿的证据，以及提供PrEP作为全面和包容性预防性健康计划的一部分的机会。我们总结了成本效益的研究，包括他们的变量的结论，因为不同的基本假设，并讨论了预算的影响，公共卫生计划和医疗保险公司的重要性。此外，我们强调需要更多的医疗保健提供者参与PrEP，以增加可及性。最后，我们提出了改进未来实施PrEP工作的建议。
Pre-exposure prophylaxis (PrEP) is a potent and underutilized HIV prevention tool. In this paper we review the state of knowledge regarding PrEP implementation for men who have sex with men and transgender persons in early adopting countries. We focus on implementation of PrEP in demonstration projects and clinical care, and describe the status of PrEP availability and uptake. We report on approaches to identifying appropriate PrEP candidates in real-world settings and on best practices for clinical monitoring. This includes the exclusion of undiagnosed HIV infection prior to PrEP initiation and longitudinal measurement of renal function, in light of safety data. Since adherence is the primary factor moderating the effectiveness of PrEP, we discuss effective adherence support interventions. Additionally, we review the evidence for risk compensation with PrEP use and opportunities to provide PrEP as part of comprehensive and inclusive preventive health programs. We summarize cost-effectiveness studies, including their variable conclusions because of differing underlying assumptions, and discuss the importance of budgetary impact for public health programs and health care insurers. Further, we emphasize a need for greater engagement of health care providers in PrEP to increase access. We conclude with recommendations for ways to improve future efforts at implementing PrEP.