Addressing Unhealthy Alcohol Use and the HIV Pre-exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review
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SUBSTANTIVE REVIEW
Addressing Unhealthy Alcohol Use and the HIV Pre‑exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review Benjamin J. Oldfield1,2 · E. Jennifer Edelman2,3 Accepted: 13 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Individuals with unhealthy alcohol use are at increased risk for HIV acquisition and may benefit from receiving HIV preexposure prophylaxis (PrEP) in primary care settings. To date, literature synthesizing what is known about the impact of unhealthy alcohol use on the PrEP care continuum with a focus on considerations for primary care is lacking. We searched OVID Medline and Web of Science from inception through March 19, 2020, to examine the extent, range, and nature of research on PrEP delivery among individuals with unhealthy alcohol use in primary care settings. We identified barriers and opportunities at each step along the PrEP care continuum, including for specific populations: adolescents, people who inject drugs, sex workers, and transgender persons. Future research should focus on identification of candidate patients, opportunities for patient engagement in novel settings, PrEP implementation strategies, and stigma reduction. Keywords HIV · Alcohol-related disorders · Primary prevention · Primary health care · Review Resumen Indivíduos con dificultades con el uso del alcohol tienen un alto riesgo de contraer VIH y podrían beneficiarse de recibir profilaxis preexposición (PrEP) de VIH en centros de cuidado primario. Hasta este momento, la literatura que sintetiza lo conocido sobre el impacto de las dificultades con el uso del alcohol en el contínuo del cuidado de PrEP, con un enfoque en los centros de cuidado primario, no es suficiente. Buscamos OVID Medline y Web of Science desde sus principios hasta el 19 de marzo, 2020, para examinar el alcance, el rango, y la naturaleza de la investigación sobre el uso de PrEP en los indivíduos con dificultades con el uso del alcohol en centros del cuidado primario. Identificamos las barreras y las oportunidades en cada paso en el contínuo del cuidado de PrEP, incluyendo para grupos específicos: adolescentes, personas que se inyectan drogas, trabajadores sexuales y personas transgéneros. Futuras investigaciones deben enfocarse en la identificación de pacientes apropriados, oportunidades para atraer la atención de los pacientes en sitios inovadores, para implementar PrEP, y para reducir el estigma.
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10461-020-03107-6) contains supplementary material, which is available to authorized users. * Benjamin J. Oldfield [email protected] 1
Fair Haven Community Health Care, 374 Grand Avenue, New Haven, CT 06513, USA
2
Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
3
Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
Globally, an estimated 1.7 million adults acquire HIV infection
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