Engaging healthcare providers to implement HIV pre-exposure prophylaxis.
Engaging healthcare providers to implement HIV pre-exposure prophylaxis.
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DOI：
10.1097/coh.0b013e3283590446
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发表时间：
2012-11
影响因子：
4.1
通讯作者：
Mayer KH
中科院分区：
文献类型：
--
作者：
Krakower D;Mayer KH
最近的随机对照试验表明，艾滋病毒暴露前预防（PrEP）可以降低几个高危人群中的艾滋病毒发病率，包括男男性行为者，血清不一致的夫妇和异性恋男性和女性。由于PrEP是一种生物医学干预措施，需要临床监测和高水平的药物依从性，最大限度地提高PrEP在现实环境中的公共卫生有效性将需要培训一批医疗保健提供者开PrEP处方。因此，了解提供者对PrEP处方的知识，实践和态度至关重要，并制定战略，吸引和培训提供者提供PrEP。有限数量的研究集中在医疗保健提供者实施PrEP。这些研究表明，一些提供者对PrEP很了解，但许多人并不了解，或者表达了疑虑。尽管许多临床医生报告愿意提供PrEP，但很少有人在临床实践中规定PrEP。提供者在艾滋病毒风险评估方面的舒适度和技能是次优的，这可能会限制最有可能从PrEP使用中受益的个人的识别。进一步的研究，以了解促进者和障碍，艾滋病毒风险评估和PrEP处方执业临床医生是必要的。创新的培训战略和决策支持干预措施可以优化PrEP的实施，因此值得进一步研究。
Recent randomized controlled trials have demonstrated that HIV Pre-Exposure Prophylaxis (PrEP) can decrease HIV incidence among several at-risk populations, including men who have sex with men, serodiscordant couples, and heterosexual men and women. As PrEP is a biomedical intervention that requires clinical monitoring and a high level of medication adherence, maximizing the public health effectiveness of PrEP in real-world settings will require the training of a cadre of healthcare providers to prescribe PrEP. Therefore it is critical to understand provider knowledge, practices and attitudes towards PrEP prescribing, and to develop strategies for engaging and training providers to provide PrEP. A limited number of studies have focused on PrEP implementation by healthcare providers. These studies suggest that some providers are knowledgeable about PrEP, but many are not, or express misgivings. Although many clinicians report willingness to provide PrEP, few have prescribed PrEP in clinical practice. Provider comfort and skills in HIV risk assessment are suboptimal, which could limit identification of individuals who are most likely to benefit from PrEP use. Further studies to understand facilitators and barriers to HIV risk assessment and PrEP prescribing by practicing clinicians are needed. Innovative training strategies and decision-support interventions for providers could optimize PrEP implementation and therefore merit additional research.