How to do it: setting up a PrEP service in an integrated sexual reproductive health service setting
How to do it: setting up a PrEP service in an integrated sexual reproductive health service setting
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DOI：
10.1136/sextrans-2018-053561
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发表时间：
2018-08-01
影响因子：
3.6
通讯作者：
Parker, Irene
中科院分区：
文献类型：
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作者：
Knapper, Carys;Birley, Humphrey;Parker, Irene
在一些试验中，暴露前预防艾滋病毒（PrEP）已被证明可以减少艾滋病毒的传播;然而，关于通过现有的英国服务提供PrEP的最佳方式的证据有限，特别是通过完全整合的性健康服务模式。Truvada形式的PrEP于2017年7月在威尔士推出。我们设立了PrEP服务，通过我们的综合性生殖健康服务提供。在提供PrEP服务的前5个月，我们发现我们的PrEP患者队列中存在不可预见的合并症、多种药物和肾损害水平。因此，我们改变了我们的服务模式，所有病人现在都在由艾滋病毒小组成员经营的预约PrEP诊所进行随访。最初每4-6周监测一次估计肾小球滤过率（eGFR）为60-70 mL/min或eGFR为60-80 mL/min且伴有影响肾功能的合并症的患者，PrEP已纳入我们现有的虚拟HIV肾脏诊所，以与肾脏医生进行讨论。PrEP团队的临床医生报告说，监测和管理PrEP队列现在更容易在其单独的格式，虽然一些患者报告说，他们更喜欢一个下降的系统。
Pre-exposure prophylaxis for HIV (PrEP) has been shown to reduce transmission of HIV in a number of trials; however, there is limited evidence regarding the optimal way to deliver PrEP through pre-existing UK services, particularly through fully integrated drop-in sexual health service models. PrEP in the form of Truvada was launched in Wales in July 2017. We set up a PrEP service to be delivered via our drop-in integrated sexual reproductive health service. In the first 5 months of PrEP service provision, we found unforeseen levels of comorbidity, polypharmacy and renal impairment in our cohort of PrEP patients. As a result, we have altered our service model and all patients are now followed up in booked appointment PrEP clinics run by members of the HIV team. Those patients with estimated glomerular filtration rate (eGFR) of 60-70 mL/min or with eGFR of 60-80 mL/min and with comorbidities impacting on renal function are monitored every 4-6 weeks initially, and PrEP has been incorporated into our pre-existing virtual HIV renal clinic for discussion with a renal physician. The PrEP team clinicians report that monitoring and managing the PrEP cohort is now easier in its appointment-only format, although some patients have reported that they would prefer a drop-in system.