The Roles of Technology in Primary HIV Prevention for Men Who Have Sex with Men
The Roles of Technology in Primary HIV Prevention for Men Who Have Sex with Men
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DOI：
10.1007/s11904-015-0293-5
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发表时间：
2015-12-01
影响因子：
4.6
通讯作者：
Stephenson, Rob
中科院分区：
文献类型：
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作者：
Sullivan, Patrick S.;Jones, Jeb;Stephenson, Rob
在全球范围内，男男性行为者（MSM）感染艾滋病毒的风险不成比例。在过去五年中，在减少艾滋病毒感染风险的生物医学干预措施方面取得了相当大的进展。要有效降低艾滋病毒发病率，就必须迅速和广泛地扩大预防工作。实现这一目标的一个机制是利用技术工具来增进知识，提高干预措施和服务的可接受性和覆盖面。本次审查提供了一个总结目前的差距，在初级预防服务的覆盖面，如何以技术为基础的干预措施和服务可以解决覆盖面的差距，以及目前的趋势，在开发和提供技术为基础的初级预防工具，供男男性行为者使用。基于代理人的MSM艾滋病毒流行模型的结果表明，40- 50%的覆盖率的多种初级艾滋病毒预防干预措施和服务，包括生物医学干预措施，如暴露前预防，将需要减少艾滋病毒的发病率在男男性接触者。在美国，除艾滋病毒检测和安全套分发外，目前所有干预措施的覆盖率都远远低于这一目标。最近的研究结果表明，以技术为基础的艾滋病毒预防工具可用于以更大规模提供某些种类的服务，而增加的成本微不足道。一项针对艾滋病初级预防的移动的应用程序的审查显示，大多数应用程序都是由非学术、非公共卫生开发人员设计的，只有一小部分可用的移动的应用程序专门针对男男性接触人群。除非我们能够利用技术，使关键服务广泛覆盖男男性行为者，否则我们不可能达到所需的男男性行为者艾滋病毒预防干预覆盖率。尽管有一系列令人兴奋的基于技术的预防工具，但在供资结构和可持续性方面存在更广泛的挑战，需要加以解决，以充分发挥这一新兴公共卫生领域的潜力。
Men who have sex with men (MSM) are at disproportionate risk for HIV infection globally. The past 5 years have seen considerable advances in biomedical interventions to reduce the risk of HIV infection. To be impactful in reducing HIV incidence requires the rapid and expansive scale-up of prevention. One mechanism for achieving this is technology-based tools to improve knowledge, acceptability, and coverage of interventions and services. This review provides a summary of the current gap in coverage of primary prevention services, how technology-based interventions and services can address gaps in coverage, and the current trends in the development and availability of technology-based primary prevention tools for use by MSM. Results from agent-based models of HIV epidemics of MSM suggest that 40-50 % coverage of multiple primary HIV prevention interventions and services, including biomedical interventions like preexposure prophylaxis, will be needed to reduce HIV incidence among MSM. In the USA, current levels of coverage for all interventions, except HIV testing and condom distribution, fall well short of this target. Recent findings illustrate how technology-based HIV prevention tools can be used to provide certain kinds of services at much larger scale, with marginal incremental costs. A review of mobile apps for primary HIV prevention revealed that most are designed by nonacademic, nonpublic health developers, and only a small proportion of available mobile apps specifically address MSM populations. We are unlikely to reach the required scale of HIV prevention intervention coverage for MSM unless we can leverage technologies to bring key services to broad coverage for MSM. Despite an exciting pipeline of technology-based prevention tools, there are broader challenges with funding structures and sustainability that need to be addressed to realize the full potential of this emerging public health field.