[Non-occupational post-exposure HIV prophylaxis. Knowledge and practices among physicians and groups with risk behavior]

Context and Barriers to the Prescription of Nonoccupational Postexposure Prophylaxis Among HIV Medical Care Providers: National Internet-Based Observational Study in China

BACKGROUND

Nonoccupational postexposure prophylaxis (nPEP) is an effective HIV biomedical prevention strategy. The research and use of nPEP are mainly concentrated in the developed world, while little is known about the knowledge, attitudes, and practices of nPEP among HIV medical care providers in developing countries.

OBJECTIVE

We aimed to assess the nPEP knowledge and prescribing practice among HIV medical care providers in mainland China.

METHODS

HIV medical care providers were recruited in China during May and June 2019 through an online survey regarding nPEP-related knowledge, attitudes, and clinical prescription experiences. Multivariable logistic regression was performed to identify factors associated with prescribing nPEP among HIV medical care providers.

RESULTS

A total of 777 eligible participants participated in this study from 133 cities in 31 provinces in China. Of the participants, 60.2% (468/777) were unfamiliar with nPEP and only 53.3% (414/777) of participants ever prescribed nPEP. HIV care providers who worked in a specialized infectious disease hospital (vs general hospital, adjusted odds ratio [aOR] 2.49; 95% CI 1.85-3.37), had practiced for 6-10 years (vs 5 or fewer years, aOR 3.28; 95% CI 2.23-4.80), had practiced for 11 years or more (vs 5 or fewer years, aOR 3.75; 95% CI 2.59-5.45), and had previously prescribed occupational PEP (oPEP, aOR 4.90; 95% CI 3.29-7.29) had a significantly positive association with prescribing nPEP. However, unfamiliarity with nPEP (aOR 0.08; 95% CI 0.05-0.11), believing nPEP may promote HIV high-risk behavior (aOR 0.53; 95% CI 0.36-0.77) or result in HIV drug resistance (aOR 0.53; 95% CI 0.36-0.77) among key populations, and self-reported having no written oPEP guideline in place (aOR 0.53; 95% CI 0.35-0.79) were negatively associated with nPEP prescription behavior.

CONCLUSIONS

HIV medical care providers have insufficient nPEP knowledge and an inadequate proportion of prescribing, which may impede the scale-up of nPEP services to curb HIV acquisition. The implementation of tailored nPEP training or retraining to HIV medical care providers would improve this situation.

End Users' Views and Preferences on Prescribing and Taking Postexposure Prophylaxis for Prevention of HIV: Methods to Support World Health Organization Guideline Development

The 2014 World Health Organization guidelines for human immunodeficiency virus postexposure prophylaxis (PEP) are the first to combine recommendations for all populations and exposures. To inform the development of these guidelines, we gathered views of end users on key aspects of PEP provision. A mixed-methods approach was used to gather views from the populations for whom the guideline will be of relevance. Data gathered from an online survey, focus group discussions, and previously collected data from in-depth interviews with key populations were used to inform the development of recommendations, in particular where there is a paucity of evidence to assess the benefits and harms of an intervention. This was a successful method to gather end users' views and preferences; however, limitations exist in the generalizability and reliability of the evidence. Future guideline development processes should consider methods to include the views of end users to guide the decision-making process.

Progress in HIV reduction and prevention among injection and noninjection drug users

Substantial progress has been made in reducing HIV among injection drug users (IDUs) in the United States, despite political and social resistance that reduced resources and restricted access to services. The record for HIV prevention among noninjecting drug users is less developed, although they are more numerous than IDUs. Newer treatments for opiate and alcohol abuse can now be integrated into primary HIV care; treatment for stimulant abuse is less developed. All drug users present challenges for newer HIV prevention strategies (eg, "test and treat," nonoccupational postexposure prophylaxis and preexposure prophylaxis, contingency management, and conditional cash transfer). A comprehensive HIV prevention program that includes multicomponent multilevel approaches (ie, individual, network, structural) has been effective in HIV prevention among IDUs. Expanding these approaches to noninjecting drug users, especially those at highest risk (eg, minority men who have sex with men) and incorporating these newer approaches is a public health priority.

Awareness of non-occupational HIV postexposure prophylaxis among French people living with HIV: the need for better targeting

BACKGROUND

Since 1998, French HIV prevention guidelines have recommended the use of HIV post-exposure prophylaxis (PEP) after unprotected sex with a HIV-positive partner who should be informed about this option. This study analysed factors associated with PEP awareness in a population of individuals living with HIV/AIDS (PLHAs).

METHODS

In 2003, a face-to-face survey was conducted among PLHAs selected from a random stratified sample of 102 French hospital departments delivering HIV care. Those who knew about PEP and those who did not were compared to identify factors related to PEP awareness in the sub-sample who reported that they had been sexually active in the prior 12 months.

RESULTS

Among the 2,280 sexually active PLHAs, the median age was 40 years. Women comprised 26% of the sample, 41% were homosexual men and 16% were immigrants. Thirty percent of individuals reported not being aware of the availability of PEP. After multiple adjustment, factors associated with lack of PEP awareness were a low educational level, unemployment, older age, and CD4 cell counts<200. In addition, homosexual men showed a higher level of PEP awareness compared with the other participants, especially when compared with immigrant heterosexual men and women. Individuals who reported having unprotected sex with a non-HIV-positive steady partner also independently showed lower levels of PEP awareness. Finally, reporting having casual partners was associated with better awareness.

CONCLUSION

Awareness of PEP is insufficient among PLHAs, especially among immigrants. Programmes aimed at improving positive prevention among PLHAs are much needed and should be promoted.