James D Mancuso, Jason Blaylock, Scott Robinson, Brian Agan
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引用次数: 0
摘要
美国军人中的艾滋病感染高危人群对艾滋病暴露前预防(PrEP)的使用仍未达到最佳水平,这导致了可预防的新发艾滋病感染,并降低了军人的医疗战备状态。应尽可能扩大 PrEP 的覆盖范围,以预防 HIV 感染并支持军事卫生系统(MHS)的四重目标。本政策分析采用了美国疾病控制与预防中心(CDC)的政策分析框架,根据证据摘要和所述干预措施制定了若干政策选项。基于 CDC 政策分析框架的评估标准纳入了军事卫生系统 (MHS) 四重目标的所有要素,包括对人口健康和战备状态的影响、对医疗体验的影响以及成本效益方面的价值。此外,还增加了一项可行性标准,以考虑影响这一政策决策的文化、社会和政治因素。这项政策分析表明,HIV PrEP 在医疗服务体系中的覆盖率仍未达到最佳水平,而几种可用的干预措施可大幅提高 PrEP 的覆盖率,进而进一步减少新服役人员的 HIV 感染并提高医疗准备状态。
Guest editorial: health policy analysis on improving HIV PrEP implementation to help end the HIV epidemic in the U.S. military.
Use of HIV pre-exposure prophylaxis (PrEP) among U.S. military service members at high risk for HIV infection remains suboptimal, resulting in preventable new HIV infections and decreased medical readiness among service members. PrEP coverage should be increased to the greatest extent possible to prevent HIV infection and support the Military Health System (MHS) quadruple aim. This policy analysis employed the Centers for Disease Control and Prevention (CDC)'s Policy Analytical Framework to develop several policy options based upon the evidence summary and interventions described. Evaluation criteria based on the CDC's Policy Analytical Framework incorporated all elements of the Military Health System (MHS)'s quadruple aim, including impact on population health and readiness, impact on the experience of care, and value in terms of cost-effectiveness. An additional criterion of feasibility was also added to account for cultural, societal, and political factors influencing this policy decision. This policy analysis suggests that HIV PrEP coverage in the MHS remains suboptimal, while several available interventions could result in substantial increases in PrEP coverage that would, in turn, result in further reductions in new service member HIV infections and increased medical readiness.