A Review of HIV Pre-exposure Prophylaxis Streamlining Strategies.
A Review of HIV Pre-exposure Prophylaxis Streamlining Strategies.
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DOI：
10.1007/s11904-020-00528-9
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发表时间：
2020-12
影响因子：
4.6
通讯作者：
Krakower DS
中科院分区：
文献类型：
--
作者：
Siegler AJ;Steehler K;Sales JM;Krakower DS
在美国，HIV暴露前预防（PrEP）的标准护理为患者、临床医生和医疗保健系统带来了巨大的负担；为了优化吸收，需要创新战略来简化其提供。我们的回顾，由扩展的慢性护理模型组成，确定了11个有希望的策略来简化PrEP护理。在作用机制上，方法范围很广。使用短信支持护理是唯一有临床试验证据支持其使用的策略。其他模式，如患者导航、远程医疗PrEP模式、可替代给药、当日处方和提供者培训，具有很有前景的试点或关联数据，似乎可能降低进入或继续护理的障碍。许多战略在艾滋病毒护理等相关领域取得了成功，在评估它们对预防措施的使用时值得考虑。减轻预防措施的负担将是使其规模化的重要组成部分。短信干预已被证明有效，值得广泛采用。鼓励其他战略的初步证据表明，建立更强有力的证据基础以阐明每项战略的效果非常重要。正在发展的证据基础不应延误这些有希望的战略的使用；相反，它要求仔细考虑每个项目如何最好地匹配其环境，以促进PrEP的处方和使用。
Standard care for HIV pre-exposure prophylaxis (PrEP) in the USA creates substantial burdens for patients, clinicians, and the healthcare system; to optimize uptake, there is a need for innovative strategies to streamline its provision. Our review, structured by the expanded chronic care model, identified eleven promising strategies to streamline PrEP care. Approaches ranged widely in mechanism of action. Using text messages to support care was the only strategy with clinical trial evidence supporting its use. Other modalities such as patient navigation, telemedicine PrEP models, alternate dosing availability, same-day prescription, and provider training have promising pilot or associational data and seem likely to lower barriers to entering into or remaining in care. Many of the strategies have established success in related domains such as HIV care, meriting consideration in evaluating their use for PrEP. Making PrEP care less burdensome will be an important part of bringing it to scale. Text message interventions have proven efficacy and merit broad adoption. Encouraging preliminary evidence for other strategies indicates the importance of building a stronger evidence base to clarify the effect of each strategy. Ongoing development of an evidence base should not delay the use of these promising strategies; instead, it calls for careful consideration for how each program may best match its environment to facilitate PrEP prescribing and use.
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