PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments.
PrEP implementation by local health departments in US cities and counties: Findings from a 2015 assessment of local health departments.
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DOI：
10.1371/journal.pone.0200338
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Hoover KW
中科院分区：
文献类型：
--
作者：
Weiss G;Smith DK;Newman S;Wiener J;Kitlas A;Hoover KW
美国公共卫生服务部于 2014 年 5 月发布了每日口服暴露前预防 (PrEP) 的临床实践指南。预计地方卫生部门 (LHD) 将在 PrEP 实施中发挥关键作用。我们对 LHD 进行了调查，以评估他们对支持 PrEP 实施的认识和兴趣、他们在支持 PrEP 中扮演的角色或认为他们应该扮演的角色，以及这样做需要哪些资源。 2015 年对 LHD 进行了调查，以评估他们对 PrEP 实施的参与情况（n = 500）。该研究采用横断面调查设计，随机选择分层样本。在做出回应的 LHD 中 (n = 284)，109 名（29%，加权比例）报告参与了 PrEP 实施。服务于大型司法管辖区（人口超过 500,000 人）且位于西部的 LHD 更有可能参与 PrEP 实施。转介 PrEP（74%）以及对社区成员进行教育和外展（51%）是参与 PrEP 实施的 LHD 最常报告的活动； 45% 的人预计会扩大他们的参与程度。在未参与 PrEP 实施的 LHD 中，13% 预计将在未来四年内参与，46% 尚未决定，41% 表示不太可能。有关卫生保健提供者的 PrEP 信息和有关卫生部门工作人员的 PrEP 信息分别是参与和不参与 PrEP 实施的 LHD 最常报告的资源需求。 LHD 的 PrEP 实施在 2015 年受到限制，即食品和药物管理局批准三年后，以及美国公共卫生服务部发布临床实践指南一年后。 PrEP 是最近推出的一项干预措施，要求 LHD 调整现有的艾滋病毒预防工作和服务提供模式。需要额外的资源和实施研究来有效支持 LHD 扩大 PrEP 规模。还必须努力提高 LHD 的 PrEP 意识、知识和实施能力。
The United States Public Health Service released clinical practice guidelines for daily oral preexposure prophylaxis (PrEP) in May 2014. Local health departments (LHDs) are expected to play a critical role in PrEP implementation. We surveyed LHDs to assess awareness of and interest in supporting PrEP implementation, what roles they were taking, or believed they should take, in supporting PrEP, and what resources would be required to do so. LHDs were surveyed in 2015 to assess their engagement in PrEP implementation (n = 500). The study employed a cross-sectional survey design with a randomly selected stratified sample. Among responding LHDs (n = 284), 109 (29%, weighted proportion) reported engagement in PrEP implementation. LHDs serving large jurisdictions (population 500,000+) and located in the West were more likely to be engaged in PrEP implementation. Making referrals for PrEP (74%) and conducting education and outreach to community members (51%) were the activities most frequently reported by LHDs engaged in PrEP implementation; 45% anticipated expanding their level of engagement. Among LHDs not engaged in PrEP implementation, 13% expected to become engaged over the next four years, 46% were undecided, and 41% reported it was unlikely. Information about PrEP for health care providers and information about PrEP for health department staff were the most frequently reported resource needs for LHDs engaged and not engaged in PrEP implementation, respectively. PrEP implementation by LHDs was limited in 2015, three years after Food and Drug Administration approval and one year after the U.S. Public Health Service issued clinical practice guidelines. PrEP is a recently available intervention that is requiring LHDs to adjust existing HIV prevention efforts and service delivery models. Additional resources and implementation research is needed to effectively support PrEP scale-up by LHDs. Efforts must also be undertaken to increase PrEP awareness, knowledge, and implementation capacity among LHDs.
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