HIV pre-exposure prophylaxis: scaling up for impact now and in the future
HIV pre-exposure prophylaxis: scaling up for impact now and in the future
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DOI：
10.1016/s2468-2667(21)00112-2
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发表时间：
2021-06-24
影响因子：
50
通讯作者：
Grulich, Andrew E.
中科院分区：
文献类型：
--
作者：
Bavinton, Benjamin R.;Grulich, Andrew E.
在首次报道口服艾滋病毒暴露前预防（PrEP）的有效性证据十多年后，全球对PrEP的采用一直不足，全球艾滋病毒预防目标未能实现。获得预防措施仍然高度集中在少数国家，即使在广泛获得预防措施的国家内，也出现了不平等现象。需要制定更加雄心勃勃的、高度优先的预防PrEP全球目标，并可以类似于90-90-90检测和治疗目标的成功方式加速艾滋病毒预防反应。卫生系统必须对PrEP友好，并允许在已经有大量艾滋病毒阴性的高危个体就诊的环境中开PrEP处方。已经提出了几个模型，以实现PrEP的更大程度的去医学化。个人层面的PrEP吸收和坚持的障碍已经被描述为特征，例如低意识，低意愿使用PrEP，以及自我认知和实际艾滋病毒风险之间的差距。克服这些障碍需要进一步努力，首先了解和解决这些障碍。新的预防措施模式正在出现；随着更多选择的出现，我们需要对不同人群使用PrEP的长期模式有更深入的了解，并开发这种使用模式，以适应人们在使用和不使用期间交替使用，以及在可用的给药方案或方式之间切换。扩大预防措施对于实现联合国艾滋病规划署2030年的预防目标至关重要。简单地让更多的人获得预防措施不能是唯一的目标：预防措施规划成功的总体定义必须是它们对艾滋病毒流行的影响。
More than a decade after the first efficacy evidence for oral HIV pre-exposure prophylaxis (PrEP) was reported, PrEP uptake globally has been inadequate and global HIV prevention targets have been missed. Access to PrEP is still highly concentrated in a fairly small number of countries and, even within countries with widespread PrEP access, inequalities have emerged. More ambitious, high-priority global targets for PrEP uptake are required and could accelerate the HIV prevention response in a similar way to the success of the 90-90-90 testing and treatment targets. Health systems must be PrEP-friendly and allow PrEP to be prescribed in settings already attended by large numbers of HIV-negative individuals who are at risk. Several models have been advanced for the greater demedicalisation of PrEP. Individual-level barriers to PrEP uptake and persistence have been characterised, such as low awareness, low willingness to use PrEP, and the gap between self-perceived and actual HIV risk. Overcoming these barriers will require further efforts to understand and address them first. New PrEP modalities are emerging; as more options become available, we need to develop a greater understanding of the long-term patterns of PrEP use in different populations and to develop models of such use that can accommodate people alternating through periods of use and non-use, as well as switching between dosing regimens or modalities as they become available. Scaling up PrEP is crucial to achieving the UNAIDS prevention targets for 2030. Simply getting more people onto PrEP cannot be the only goal: the big-picture definition of success for PrEP programmes must be their impact on the HIV epidemic.