Equitable coverage for HIV-Pre-Exposure Prophylaxis and optimization of HIV Prevention programme delivery

背景口服HIV暴露前预防（PrEP）是一种非常有效的减少HIV感染的生物医学干预措施，是WHO推荐的HIV预防综合方法的一部分1。在英格兰，PrEP可以通过许多不同的途径获得，包括：1）医生的私人处方（患者的费用为每月400英镑; 2）私人在线提供商（患者的费用为每月35- 45英镑）; 3）正在进行的实施试验（PrEP影响试验），由NHS英格兰资助（患者无费用）。PrEP影响试验将在性健康诊所进行到2020年10月，并将收集生物医学结果数据（即，符合PrEP资格标准的诊所就诊者比例，处方PrEP的比例，其资格的持续时间; HIV/STI诊断;不良事件）。然而，仅收集试验参与者的数据;关于不参加性健康诊所的人的资格以及更广泛社区的态度仍然存在问题。PrEP提供计划已在全球许多地方实施，然而，有报告称某些人群的接受率较低，包括男男性行为者（MSM）2，3和异性恋男性和女性2。此外，尽管英格兰的新艾滋病毒诊断率有所下降，但并非所有群体，例如异性恋男性和女性，都出现了持续或相等的下降率4。这些人群可能受益于干预措施，以提高PrEP的认识，吸收和坚持。为了确定哪些人群最需要干预措施，需要估计有资格接受PrEP的风险人群以及该人群的摄入量。英格兰有资格接受PrEP的男男性接触者人数估计为5，然而，其他风险群体，包括黑人和少数民族异性恋男性和女性，特征不太清楚。目前没有标准化的措施来评估风险人群的吸收，覆盖范围和需求。这种措施可以用来评估当前和未来的PrEP实施方案，并确定可以从额外干预措施中受益的群体，以增加吸收和支持PrEP依从性。总体目标这项工作的目的是制定一项措施，公平的PrEP覆盖率在英格兰艾滋病毒的高风险人群，并探讨障碍和促进PrEP的访问，摄取和坚持。

Background Oral HIV Pre-Exposure prophylaxis (PrEP) is a highly effective biomedical intervention for reducing HIV acquisition, and is recommended by the WHO as part of a comprehensive approach to HIV prevention1. In England, PrEP can be acquired through a number of different routes, including: 1) A private prescription from a doctor (cost to patient is £400 per month; 2) private online providers (cost to patient is £35-£45 a month); 3) an ongoing implementation trial (the PrEP Impact Trial), funded by NHS England (no cost to patient). The PrEP Impact Trial will run until October 2020 in sexual health clinics and will collect biomedical outcome data (i.e., the proportion of clinic attendees meeting PrEP eligibility criteria, proportion prescribed PrEP, duration of their eligibility; HIV/STI diagnoses; adverse events). However, only data on trial participants will be collected; questions remain regarding eligibility among people who do not attend sexual health clinics, and the attitudes of the wider community.PrEP provision programmes have been implemented in many locations worldwide, however, there have been reports of low uptake among certain populations, including young men who have sex with men (MSM) 2,3 and heterosexual men and women2. Furthermore, despite a fall in the rate of new HIV diagnoses in England, not all groups, for example heterosexual men and women, have seen sustained or equal rates of decline4. These populations may benefit from interventions to increase PrEP awareness, uptake, and adherence. In order to identify which populations are most at need of interventions, requires both an estimation of the at risk population eligible for PrEP, and the uptake within that population. The population of MSM in England who are eligible for PrEP has been estimated5, however, other risk groups, including black and minority ethnic heterosexual men and women, are less well characterised.There is currently no standardised measure to evaluate uptake, coverage and need in at-risk populations. Such a measure could be used to evaluate current and future PrEP implementation programmes, and identify groups that could benefit from additional interventions to increase uptake and support PrEP adherence. Overall AimThe aim of this work is to develop a measure of equitable PrEP coverage for populations at high risk of HIV in England, and explore the barriers and facilitators to PrEP access, uptake and adherence.