Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.
Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.
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DOI：
10.1016/j.amepre.2021.05.027
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发表时间：
2021-11
影响因子：
5.5
通讯作者：
Ojikutu BO
中科院分区：
文献类型：
--
作者：
Bonacci RA;Smith DK;Ojikutu BO
暴露前预防（PrEP）在预防艾滋病毒感染方面非常有效，是美国终止艾滋病毒流行倡议的关键工具。然而，暴露前预防连续体中的主要种族和民族差异，继发于结构性不平等和系统性种族主义，威胁着进展。在个人、网络、卫生保健和结构层面存在许多障碍，阻碍了黑人和西班牙裔/拉丁裔社区获得和接受PrEP。本综述概述了这些障碍，以及卫生部门、卫生保健组织和社区合作伙伴实施的创新和协作解决方案，以增加PrEP的提供和在不成比例的受影响社区中的吸收。在个人和网络层面上，有希望的战略侧重于在整个PrEP连续体中增加患者支持，定位和培训社区成员以扩大PrEP的知识和兴趣，以及利用移动技术支持PrEP的采用。医疗保健层面的解决方案包括扩大可以提供PrEP的场所和医疗保健专业人员的类型，以及结构和政策层面的选择，重点是财政援助计划和医疗保险的扩大。主要的研究差距包括证明试点研究和干预措施在规模和不同背景下仍然有效。尽管过去20年为终结艾滋病毒流行提供了有效的手段，但要实现美国的这一愿景，就需要解决黑人和西班牙裔/拉丁裔社区中与艾滋病毒有关的持续和普遍的差异。联邦、州和地方合作伙伴应加大努力，解决长期存在的卫生和结构性不平等问题，并与受到严重影响的社区合作，迅速扩大预防PrEP的规模。
Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operating at the individual, network, healthcare, and structural levels, impede PrEP access and uptake within Black and Hispanic/Latino communities. This review provides an overview of those barriers and the innovative and collaborative solutions that health departments, healthcare organizations, and community partners have implemented to increase PrEP provision and uptake among disproportionately affected communities. Promising strategies at the individual and network levels focus on increasing patient support throughout the PrEP continuum, positioning and training community members to expand knowledge of and interest in PrEP, and leveraging mobile technologies to support PrEP uptake. Healthcare-level solutions include expanding the venues and types of healthcare professionals that can provide PrEP, and structural- and policy-level options focus on financial assistance programs and health insurance expansion. Key research gaps include demonstrating that pilot studies and interventions remain effective at scale and across varied contexts. Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U.S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.
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影响因子：
1.8
作者：
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通讯作者：
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DOI：
10.1097/qai.0000000000002042
发表时间：
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