Preexposure prophylaxis strategies for African-American women affected by mass incarceration.
Preexposure prophylaxis strategies for African-American women affected by mass incarceration.
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受大规模监禁影响的非裔美国妇女的暴露前预防策略。
DOI：
10.1097/qad.0000000000002749
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发表时间：
2021-03-01
期刊：
影响因子：
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通讯作者：
Marshall BDL
中科院分区：
文献类型：
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作者：
Adams JW;Khan MR;Bessey SE;Friedman SR;McMahon JM;Lurie MN;Galea S;Marshall BDL
我们的目的是确定各种暴露前预防（PrEP）处方策略对城市环境中受大规模监禁影响的非裔美国妇女的有效性。一个基于代理人的模型被用来评估预防策略，在一个有效的，道德的方式。通过定义代理，他们的特点和关系，我们评估了人口水平的影响，准备艾滋病毒的发病率。我们在代表宾夕法尼亚州费城非裔美国人的模拟中测试了假设的PrEP处方策略。评估了四项战略：为符合CDC关于伴侣特征的指标的妇女提供PrEP，为最近被监禁的男性伴侣的妇女提供PrEP，为最近被释放的男性伴侣的妇女提供PrEP，以及在释放时基于夫妇的PrEP。在扩大HAART的同时进行了干预。我们评估了艾滋病毒传播的减少，避免一次艾滋病毒传播（NNT）所需的PrEP人数以及由此产生的PrEP人数比例。基于刑事司法系统参与的PrEP处方方案减少了艾滋病毒传播。NNT的范围从147（基于夫妇的场景）到300（最近发布的场景）。在任何一个时间，PrEP覆盖的女性人口的百分比范围从0.14%（基于夫妇）到10.8%（基于CDC）。CDC的指导方针的情况下，一贯效率较低的司法介入相比。应考虑在国家艾滋病毒预防目标中扩大受监禁影响的非洲裔美国妇女及其男性伴侣的PrEP，并将惩教设施作为干预场所。合作伙伴的特点，在目前的疾病预防控制中心的迹象可能是更有效和更高效的，如果准则考虑刑事司法参与。
We aimed to determine the effectiveness of various preexposure prophylaxis (PrEP) prescription strategies for African–American women impacted by mass incarceration within an urban setting. An agent-based model was utilized to evaluate prevention strategies in an efficient, ethical manner. By defining agents, their characteristics and relationships, we assessed population-level effects of PrEP on HIV incidence. We tested hypothetical PrEP prescription strategies within a simulation representing the African–American population of Philadelphia, Pennsylvania. Four strategies were evaluated: PrEP for women meeting CDC indicators regarding partner characteristics, PrEP for women with a recently incarcerated male partner, PrEP for women with a recently released male partner and couples-based PrEP at time of release. Interventions occurred alongside scale-up of HAART. We evaluated reductions in HIV transmissions, the number of persons on PrEP needed to avert one HIV transmission (NNT) and the resulting proportions of people on PrEP. Scenarios prescribing PrEP based on criminal justice system involvement reduced HIV transmissions. The NNT ranged from 147 (couples-based scenario) to 300 (recently released scenario). The percentage of the female population covered by PrEP at any one time ranged from 0.14% (couples-based) to 10.8% (CDC-based). CDC-guideline scenarios were consistently less efficient compared to the justice-involved interventions. Expanding PrEP for African–American women and their male partners affected by incarceration should be considered in national HIV prevention goals and correctional facilities leveraged as intervention sites. Partner characteristics in the current CDC indications may be more effective and efficient if guidelines considered criminal justice involvement.