Judith D. Auerbach, Siobhan Malone, Andrew D. Forsyth
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引用次数: 0
Abstract
Introduction
Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs.
Methods
We conducted a scoping review to elucidate factors influencing HCWs’ use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post-exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes.
Results
Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs’ uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma.
Discussion
Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs’ PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs’ PEP use.
Conclusions
Lessons from HCWs’ experience in LMICs may inform understanding of PEP under-use among people in these settings with non-occupational exposures.
导言:暴露后预防(PEP)是一种有效的预防方法,只要在艾滋病病毒暴露后及时启动即可。然而,PEP 的使用率一直不高,即使是在制定了 PEP 政策和程序并可获得 PEP 药物的医疗机构中发生职业暴露的医护人员(HCWs)也是如此。在看似最佳的情况下,了解不均衡使用 PEP 的动态以更好地保护医护人员的健康和福祉非常重要:我们进行了一次范围界定审查,以阐明影响高危工人在职业暴露后使用 PEP 的因素。我们使用 HIV、暴露后/暴露后预防、可接受性、医护人员以及价值观和偏好等术语在 PubMed、PsychInfo 和 Google Scholar 上检索了 2014 年至 2022 年发表的同行评审英文文献。对所获得的 53 项研究进行归纳叙述式综述,确定了核心主题:几乎所有涉及各种医护人员类型和环境的研究(96%)都发生在非洲和亚洲的中低收入国家(LMICs)。确定的主题沿着 PEP 使用经验的轨迹排列:认识/了解;可接受性;可用性/可及性;接受/使用;坚持/完成。在所有研究中,人们对 PEP 用于艾滋病预防的认知度较高,对药物治疗方案和医疗机构政策的了解程度为中等至较低;对 PEP 的接受程度为中等至较高;对 PEP 可及性/可得性的认识不一致,且因地理位置和环境而异;由于不知道如何报告暴露情况以及不了解 PEP 的可用性,医务工作者对 PEP 的接受程度较低;PEP 方案的依从性/完成率为中低水平,副作用以及认为完成方案无需避免血清转换的观点阻碍了 PEP 方案的依从性/完成率。医务工作者一直对艾滋病耻辱化表示担忧:讨论:由于各研究中使用的概念不一致,以及报告暴露事件的方法不明确,研究结果受到了限制。需要采取多层次的方法来解决个人、社会和结构性障碍之间的相互作用,这些障碍削弱了医护人员使用 PEP 的积极性。加强培训、事件报告、24 小时提供无污名化的 PEP 服务以及监测坚持/完成情况对于优化医护人员使用 PEP 至关重要:结论:从低收入国家和地区的医务工作者的经验中汲取的教训可帮助我们了解在这些环境中,非职业接触者对 PEP 使用不足的情况。
期刊介绍:
The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.