The role of healthcare providers in the roll out of preexposure prophylaxis.
The role of healthcare providers in the roll out of preexposure prophylaxis.
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DOI：
10.1097/coh.0000000000000206
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发表时间：
2016-01
影响因子：
4.1
通讯作者：
Mayer KH
中科院分区：
文献类型：
--
作者：
Krakower DS;Mayer KH
回顾评估医疗保健从业者提供抗 HIV 暴露前预防 (PrEP) 准备情况的最新研究，并为未来实施研究的领域提出建议。由于 PrEP 是一种生物行为干预措施，因此医疗保健提供者可能在护理环境中实施 PrEP 方面发挥关键作用。研究表明，许多专业提供者都了解 PrEP 并支持将其作为公共卫生干预措施提供，尽管通才的了解和接受程度较低。因此，临床医生对 PrEP 的使用仅限于少数早期采用者。对 PrEP 有效性和长期安全性的担忧，以及开具 PrEP 处方的障碍，可能会限制处方行为和意图。尽管正在开发帮助临床医生定期进行风险评估的创新工具，但临床医生拒绝进行常规 HIV 风险评估是实施 PrEP 的另一个障碍。需要采取干预措施，让更广泛的医疗保健提供者参与 PrEP 的提供。本综述利用基于创新传播理论的框架，提出了可以实施和评估的策略，以增加医疗保健提供者的 PrEP 处方。如果投入资源来培训临床医生提供 PrEP，那么这些利益相关者可以加强 PrEP 的使用，作为主要提供者预防方案的一部分。
To review the most recent studies assessing the preparedness of healthcare practitioners to provide anti-HIV pre-exposure prophylaxis (PrEP) and to suggest areas for future implementation research. As PrEP is a bio-behavioral intervention, healthcare providers are likely to play a critical role in implementing PrEP in care settings. Studies suggest that many specialized providers are aware of PrEP and support its provision as a public health intervention, though knowledge and acceptance are less among generalists. Therefore, utilization of PrEP by clinicians has been limited to a few early adopters. Concerns about the efficacy and long-term safety of PrEP, and perceived barriers to prescribing PrEP, could limit prescribing behaviors and intentions. Resistance to performing routine HIV risk assessments by clinicians is an additional barrier to implementing PrEP, though innovative tools to help clinicians routinely perform risk assessments are being developed. Interventions are needed to engage a broader array of healthcare providers in PrEP provision. Utilizing a framework based on diffusion of innovation theory, this review proposes strategies that can be implemented and evaluated to increase PrEP prescribing by healthcare providers. If resources are invested in training clinicians to provide PrEP, then these stakeholders could enhance the use of PrEP as part of a prevention package by primary providers.