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Social marketing strategy to increase awareness of non-occupational post-exposure prophylaxis (NPEP) followed by increased NPEP awareness and more appropriate use

机译：社会营销策略，以提高人们对非职业性暴露后预防（NPEP）的认识，然后提高对NPEP的认识并更适当地使用

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The aim of non-occupational post-exposure prophylaxis (NPEP) is to interrupt HIV replication and prevent establishment of infection.1,2 The effectiveness of treatment depends on prompt initiation and completion of a 4-week course of anti-retroviral therapy.3 Awareness of the availability of NPEP is crucial to the uptake of the program.nnNational NPEP guidelines were developed in 2001.3 In 2002, Western Australia (WA) adapted these guidelines to the local context4 and the WA NPEP database was established. The low level of awareness of NPEP, demonstrated in the 20025 and 20046 surveys of the gay community of Perth, and anecdotal reports of inappropriate use of NPEP, triggered the development of a social marketing strategy, which began in May 2005 and is ongoing. The strategy targeted gay men, and other groups at risk of acquiring HIV infection, through gay community press advertising, gay venue-based promotion, and supporting strategies. In addition, guidelines on the use of NPEP were disseminated to general practitioners and health care providers in Emergency Departments and Sexual Health Clinics.nnAwareness of NPEP among gay men was measured by comparing the results of gay community periodic surveys in Perth, WA, conducted in 2002 and 2004 (pre-communication strategy)5,6 and in 2006 (post-communication strategy).7 NPEP use and compliance were measured using data from the WA NPEP database. We analysed all cases on the WA NPEP database from 1 May 2002 to 30 April 2008. We made comparisons between characteristics of recipients and compliance with guidelines before and after 1 May 2005, corresponding to the pre- and post-communication strategy timeframes.nnAfter the commencement of the strategy, awareness of NPEP among gay men in Perth nearly doubled (48.2% in 2006 v. 26% in 2004, P < 0.001)6,7 and the number of people receiving NPEP increased by 26%. The proportions of male and men who have sex with men (MSM) NPEP recipients more than doubled and the proportion of recipients who met the criteria for NPEP increased significantly from 61% to 89% (P = 0.000). More recipients completed the 4-week treatment regime after the strategy (60% compared with 48%, P = 0.047) but the timeliness of treatment did not change, with >90% starting treatment within 72 h (Table 1). Loss to follow up remained significant at 60% at 6 months.nnThe temporal relationship between the social marketing strategy and the increase in the proportion and number of MSM recipients receiving NPEP, and the apparent increased awareness of NPEP among this high risk group, is consistent with the intended effect of the strategy. The reversal of gender ratio was due to a combination of more MSM accessing NPEP and fewer women receiving NPEP inappropriately following sexual assault, resulting in an increase to 89% in the proportion of recipients who met the criteria for initiation of NPEP. This increase is also temporally associated with the social marketing strategy.nnThe main limitation of this analysis is the high proportion of clients who were lost to follow up. Several clients were known to have returned overseas or interstate and may have completed treatment and follow up outside WA. It is likely that the analysis underestimated the proportion that completed treatment. Although there was no documented HIV sero-conversion, it is possible that this could have occurred without notification to the WA NPEP database. It is also possible that other unidentified factors also contributed to the increase in awareness of NPEP over time.nnIn conclusion, it is reassuring that WA’s NPEP social marketing campaign was followed by increased awareness of NPEP in the target group (gay men) and more appropriate use of NPEP.
机译：非职业性接触后预防（NPEP）的目的是中断HIV复制并防止感染的建立。1,2治疗的有效性取决于迅速开始和完成为期4周的抗逆转录病毒治疗3。意识到NPEP的可用性对于计划的实施至关重要。国家NPEP指南于2001.3年制定。2002年，西澳大利亚州（WA）根据当地情况对这些指南进行了调整4，并建立了WA NPEP数据库。对珀斯同性恋社区的20025年和20046年调查显示，人们对NPEP的了解程度低，以及关于不正确使用NPEP的传闻，触发了一项社会营销策略的发展，该策略始于2005年5月，目前正在进行中。该策略通过同性恋社区媒体广告，基于同性恋场所的促销和支持策略，针对同性恋男子和其他可能感染艾滋病毒的人群。此外，还向急诊科和性健康诊所的全科医生和卫生保健提供者分发了使用NPEP的指南.nn通过比较在华盛顿州珀斯市进行的同性恋社区定期调查的结果，对男同性恋者的NPEP意识进行了衡量。 2002年和2004年（沟通前策略）5,6和2006年（沟通后策略）。7使用WA NPEP数据库中的数据测量了NPEP的使用和遵从性。我们分析了2002年5月1日至2008年4月30日在WA NPEP数据库中的所有案件。我们对接受者的特征与2005年5月1日之前和之后的准则遵循情况进行了比较，这与沟通前后策略的时限相对应。该战略开始实施后，珀斯男同性恋者对NPEP的意识几乎翻了一番（2006年为48.2％，2004年为26％，P <0.001）6,7，而接受NPEP的人数增加了26％。与NPEP男性做爱（MSM）的男性和男性比例增加了一倍以上，达到NPEP标准的接受者比例从61％显着增加到89％（P = 0.000）。该策略后有更多的接受者完成了为期4周的治疗方案（60％比48％，P = 0.047），但治疗的及时性没有改变，在72小时内开始治疗的比例大于90％（表1）。随访6个月的损失仍然高达60％。nn社会营销策略与接受NPEP的MSM接受者的比例和数量增加之间的时间关系，以及这一高风险人群中NPEP意识的明显提高是一致的与该策略的预期效果。性别比例的逆转归因于更多的MSM进入NPEP，以及更少的性侵犯后不适当地接受NPEP的妇女，从而使符合NPEP起始标准的接受者比例增加到89％。这种增加在时间上也与社会营销策略相关。nn该分析的主要局限性在于失去跟进的客户比例很高。已知有几位客户已返回海外或跨州，并且可能已完成治疗并在西澳以外地区进行了跟进。分析可能低估了完成治疗的比例。尽管没有记录到的HIV血清转化，但有可能在没有通知WA NPEP数据库的情况下发生了。随着时间的流逝，其他未知的因素也可能导致NPEP意识的提高。nn总而言之，可以放心的是，在西澳州的NPEP社会营销活动之后，目标群体（同性恋者）对NPEP的意识也有所提高，并且更合适使用NPEP。

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    《Sexual Health》 |2009年第4期|p.348-349|共2页
  • 作者

    Revle Bangor-Jones Donna Mak Susan Laing and Graham Brown;

  • 作者单位

    A Government of Western Australia, Department of Health, WA, Communicable Disease Control Directorate, PO Box 8172, Perth Business Centre, Western Australia 6849, Australia. B Western Australian Centre for Health Promotion Research, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia. C Corresponding author. Email: revle.bangor-jones@health.wa.gov.au;

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