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Mekonnen G, Liknaw T, Anley A, Afenigus AD. Knowledge, attitudes, and associated factors towards HIV pre-exposure prophylaxis among health care providers. Sci Rep 2024; 14:6168. [PMID: 38485990 PMCID: PMC10940609 DOI: 10.1038/s41598-024-56371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
The knowledge and attitudes of health care providers were limited as reviewed in many studies. Attitudes and knowledge about pre-exposure prophylaxis among healthcare providers have not been investigated in Ethiopia even though pre-exposure prophylaxis is a novel healthcare topic. The aim was to assess knowledge, attitudes, and associated factors towards pre-exposure prophylaxis among healthcare providers in Gojjam health facilities, North West Ethiopia, 2022. An institutional-based cross-sectional study was conducted from June 1-30 among 410 healthcare providers in public health facilities in the East Gojjam zone. A simple random sampling technique was used to recruit the required study participants. The statistical program EPI Data version 4.6 was used to enter the data, and statistical packages for Social science version 25 was used for analysis. Variables with a p-value less than 0.25 in the bivariable analysis were included in the multivariable logistic regression analysis. Statistical significance was determined with a p-value less than 0.05. The good knowledge and the favorable attitude of healthcare providers toward HIV pre-exposure prophylaxis were 55.7% (50.6-60.2%) and 60.2% (55.0-65.0%) respectively. male participant (AOR 1.67; 95% CI (1.01-2.55), service year ≥ 10 years (AOR 2.52; 95% CI (1.23-5.17), favorable attitudes (AOR 1.92; 95%CI (1.25-2.95), and providers good sexual behavior (AOR 1.85; 95%CI (1.21-2.82) were significantly associated with the good knowledge, and training (AOR 2.15; 95% CI (1.23-3.76), reading the guideline (AOR 1.66; 95% CI (1.02-2.70), and good knowledge (AOR 1.78; 95% CI (1.16-2.75) was significantly associated with the favorable attitudes. In general, the finding of this study shows that the knowledge and attitudes of healthcare providers were low. Since this is a new initiative their knowledge is lower than their attitudes. Male, service year 10 years, and good provider sexual behavior were factors significantly associated with good knowledge. Training, reading the guidelines, and good knowledge were factors significantly associated with a favorable attitudes. As a result, healthcare facilities intervention programs and strategies better target these factors to improve the knowledge and attitudes of healthcare providers. Preparing training programs to enhance knowledge and attitudes towards PrEP is recommended.
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Affiliation(s)
- Getachew Mekonnen
- Department of Nursing, Shebel Berenta Hospital, Shebel Berenta, Ethiopia.
| | - Tiliksew Liknaw
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alemayehu Anley
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abebe Dilie Afenigus
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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2
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Bailey VC, Kleinhans AV, Mokgatle MM. Knowledge and attitudes of HIV pre-exposure prophylaxis among nurses in South Africa. Afr J Prim Health Care Fam Med 2023; 15:e1-e6. [PMID: 37916728 DOI: 10.4102/phcfm.v15i1.4086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) has shown efficacy and effectiveness in populations who practise high-risk sexual activity. Nurses' knowledge and positive attitudes enhance PrEP implementation. AIM This study aimed to investigate the knowledge of and attitudes towards PrEP among nurses in primary health care facilities. SETTING The study was conducted in 10 health facilities that offer comprehensive services in Tshwane, South Africa. METHODS A cross-sectional survey assessed the knowledge of and attitudes towards PrEP among 114 nurses. Univariate, bivariate and logistic regressions were performed to estimate odds ratios and to determine whether age, sex and education had an association with the knowledge and attitudes. RESULTS Majority of the study sample consisted of female nurses (92.1%), and most respondents (68%) had moderate PrEP knowledge. Logistic regression showed that age and education were not associated with high level of knowledge. Pre-exposure prophylaxis was viewed negatively by 84.5% of the respondents. The odds of positive attitudes towards PrEP were 1.92 times higher among males than females (95% CI 0.54-6.83) and 1.24 times higher among nurses who had bachelor's degree than diploma holders (95% CI 0.51-3.01). CONCLUSION This study found that there is a need to strengthen the dissemination of information about PrEP, and nurses in South Africa require training to improve their knowledge of and attitudes towards PrEP.Contribution: The findings of the study add to the current knowledge base regarding PrEP access in the public healthcare system and it highlights gaps in the training of healthcare providers.
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Affiliation(s)
- Veronique C Bailey
- Department of Public Health, School of Healthcare Sciences, Sefako Makgatho Health Sciences University, Tshwane.
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3
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Fitzgerald N, Coltart H, Dominguez L, Flanagan K, Gilleece Y. PrEP for women in Europe: a systematic literature review. HIV Med 2023. [PMID: 37088558 DOI: 10.1111/hiv.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/03/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Prevention of HIV transmission is fundamental to ending the HIV epidemic. Pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine (TDF-FTC) is an established HIV-prevention method; however, most PrEP services in Europe have been targeted at men who have sex with men (MSM). A survey in 2021 by Women Against Viruses in Europe (WAVE) showed considerable variation in PrEP access and guidance for women throughout Europe. WAVE therefore commissioned this systematic review to provide insight into PrEP provision and barriers to uptake for women in Europe. METHODS PubMed, Embase, and Scopus were searched for studies (January 2013-May 2021) that reported on actual (e.g., efficacy and safety) or hypothetical (e.g., awareness, barriers, PrEP impact models) use of oral PrEP involving women (including cis, transgender, pregnant, migrant, and breastfeeding women). Search terms included HIV, pre-exposure prophylaxis (specifically TDF-FTC), and women. Studies performed outside of the World Health Organization European region were excluded. RESULTS The search identified 4716 unique citations, and 45 peer-reviewed articles (44 studies) were included. The majority of these studies (34/44 [77%]) included recipients or potential recipients of PrEP, representing 4699 women (243 transgender women). However, few studies were women focused (4/34 [12%]) or took place outside of Western Europe (3/34 [9%]). Across the three clinical studies that reported women-specific outcomes (60 transgender women, 13 pregnant, and 19 cis women), no breakthrough infections were recorded during the use of PrEP. Lack of awareness of PrEP, low self-estimation of HIV acquisition risk, concerns about stigma, lack of protection against other sexually transmitted infections, and PrEP interaction with hormones (for transgender women) were identified as barriers to use. The remaining studies examined healthcare professionals' perceptions of PrEP (9/44 [20%]), asked for public opinion (2/44 [5%]), or modelled the potential of PrEP for HIV prevention (1/44 [2%]). CONCLUSIONS This review revealed a notable lack of literature on PrEP for cis and transgender women in Europe. This is synonymous with a lack of PrEP provision for women in this region. Barriers to PrEP uptake are complex and rooted in institutional and societal stigma, which must be addressed at policy level. HIV prevention with PrEP is not 'one size fits all' and requires a nuanced gender-responsive approach. Further research into the use of PrEP in cis, pregnant, breastfeeding, and transgender women is essential if we are to stop HIV transmission by 2030.
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Affiliation(s)
| | | | | | | | - Yvonne Gilleece
- Brighton & Sussex Medical School, Brighton, UK
- The Lawson Unit, Royal Sussex County Hospital, Brighton, UK
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4
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Martínez-Cajas J, Alvarado-Llano B, Martínez-Buitrago E, Torres-Isasiga J, Arrivillaga M, Camargo P, Galindo-Orrego X, Mueses-Marín H. AC-2020-12-1420.R1 - HIV care providers' familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study. AIDS Care 2022; 34:1428-1434. [PMID: 35067114 DOI: 10.1080/09540121.2022.2029813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In 2019, Colombia approved the combination of tenofovir disoproxil fumarate/emtricitabine for HIV Pre-Exposure Prophylaxis (PrEP). Therefore, we conducted a situational analysis in HIV-care providers to identify barriers and facilitators for PrEP implementation. A survey was applied to a non-probabilistic sample of health care workers of HIV-specialized clinics. We examined PrEP awareness and familiarity, comfort with PrEP-related activities, perceived barriers for PrEP implementation, concerns, and attitudes. Poisson regressions assessed the relationship between these factors and the variable "having a plan to offer PrEP". The participation rate was 41% and included physicians (42.6%) and other health professionals (57.4%). Fifty-one percent of the participants reported more than five years of experience caring for people living with HIV. Forty-two percent of non-physician health care workers were nurses. Most reported high familiarity/comfort with PrEP-relevant activities. Concerns about PrEP were prevalent (> 50%) and included causing more harm than good, reducing condom use, medication non-adherence, drug resistance, and healthcare system barriers. Physicians had a plan to offer PrEP (72.2%) more often than other health professionals (52.6). Having a plan to offer PrEP was related to PrEP knowledge and comfort assessing sexual behavior and providing HIV counseling. Overall, about half of HIV-care providers seemed ready to offer PrEP and constitute an asset for PrEP implementation efforts in Colombia. PrEP awareness among non-physicians, PrEP concerns, and negative attitudes need to be addressed to enhance implementation.
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Affiliation(s)
| | | | - Ernesto Martínez-Buitrago
- Hospital Universitario del Valle Evaristo García, Unidad de Epidemiología, Universidad del Valle, Cali, Colombia
| | - Julian Torres-Isasiga
- Albert Einstein College of Medicine and Montefiore Medical Center, Division of Infectious Diseases, Bronx, NY, USA
| | | | - Pilar Camargo
- Queen's University, School of Nursing. Kingston Ontario, Canada
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Martinez-Cajas JL, Torres J, Mueses HF, Plazas PC, Arrivillaga M, Gomez SA, Galindo X, Buitrago EM, Llano BEA. Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study. Implement Sci Commun 2022; 3:31. [PMID: 35296369 PMCID: PMC8925047 DOI: 10.1186/s43058-022-00278-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP. Methods We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks’ domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation. Results We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care. Conclusion Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00278-2.
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Affiliation(s)
- Jorge Luis Martinez-Cajas
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, K7L 3 N6, Canada
| | - Julian Torres
- Montefiore Medical Center, Moses Division, Albert Einstein College of Medicine, The Oval Center at Montefiore, 3230 Bainbridge Ave, Bronx, NY, 10467, USA
| | | | | | - Marcela Arrivillaga
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Sheila Andrea Gomez
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Ximena Galindo
- Corporación de Lucha Contra el Sida, Carrera 56 2- 120, Cali, Colombia
| | - Ernesto Martinez Buitrago
- Departamento de Medicina Interna, Universidad del Valle, Calle 5 36-08 Hospital Universitario del Valle, Cali, Colombia
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Rao S, Reed AE, Parchem B, Edelman EJ, Magnus M, Hansen NB, Kershaw TS, Earnshaw VA, Krakower DS, Dovidio JF, Mayer KH, Underhill K, Rosenberger JG, Ogburn DF, Betancourt JR, Calabrese SK. Optimizing Provider Preexposure Prophylaxis (PrEP) Training: A Cross-Sectional Analysis of Recommendations from Providers Across the PrEP Implementation Cascade. AIDS Behav 2022; 26:218-231. [PMID: 34287754 PMCID: PMC8294250 DOI: 10.1007/s10461-021-03375-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Expanding PrEP access necessitates training that supports healthcare providers’ progression along the PrEP implementation cascade, moving from PrEP awareness to prescription. We surveyed 359 USA providers about PrEP training content and format recommendations. We examined the association between cascade location and training recommendations. Most providers were aware of PrEP (100%), willing to prescribe PrEP (97.2%), had discussed PrEP with patients (92.2%), and had prescribed PrEP (79.9%). Latent class regression analysis revealed that cascade location was associated with training recommendations. Although all providers recommended PrEP-specific content (e.g., patient eligibility), providers who were located further along the cascade also recommended more comprehensive content, including sexual history-taking and sexual and gender minority competence training. Providers further along the cascade were also more likely to recommend interactive training formats (e.g., role-playing). These insights from providers furthest along the cascade indicate the importance of including comprehensive content and interactive formats in future PrEP training initiatives.
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Affiliation(s)
- Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA.
| | - Ashley E Reed
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - Benjamin Parchem
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington DC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | | | - Kenneth H Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Kristen Underhill
- Population and Family Health and Law, Columbia University, New York City, NY, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Hyattsville, MD, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
- Department of Prevention and Community Health, Milken School of Public Health, George Washington University, Washington, DC, USA
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7
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Bunting SR, Feinstein BA, Hazra A, Sheth NK, Garber SS. Knowledge of HIV and HIV pre-exposure prophylaxis among medical and pharmacy students: A national, multi-site, cross-sectional study. Prev Med Rep 2021; 24:101590. [PMID: 34976649 PMCID: PMC8683973 DOI: 10.1016/j.pmedr.2021.101590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing HIV. However, prescription of PrEP has not reached the scale that is necessary to meet the public health need of reducing HIV incidence. A factor contributing to this slow scale-up is limited healthcare practitioners' knowledge of PrEP, making PrEP education a priority. We conducted a national, cross-sectional study of medical (allopathic and osteopathic) and pharmacy students regarding knowledge of PrEP and HIV between October 2020 and February 2021. We included 28 items in our knowledge assessment. Analysis sought to identify gaps in knowledge as well as academic and demographic correlates of knowledge. A total of 2,353 students participated in the study (response rate = 17.0%). The overall mean HIV knowledge score was 79.6% correct. Regarding specific items, 68.7% of participants believed HIV treatment was difficult because it required many pills, and 61.1% incorrectly indicated a person with an undetectable HIV viral load could transmit the virus to their sexual partners. Overall mean PrEP knowledge was 84.1%. Approximately one-third of participants did not identify HIV-negative status as a requirement to be a PrEP candidate. Gay/lesbian participants and those who were in the late-phase of training reported higher knowledge of both HIV and PrEP than did heterosexual participants and those in the early-phase of training. This study identifies specific gaps in training on HIV prevention with PrEP that must be improved in health professions education to ensure PrEP reaches its full potential in ending the HIV epidemic.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago Medical Center, Chicago, IL, USA
| | - Brian A Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medical Center, Chicago, IL, USA
| | - Neeral K Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sarah S Garber
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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8
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A cross-sectional survey of general practitioner knowledge, attitudes, and clinical experience of HIV PrEP. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Aim
Norway’s health scheme provides no-cost HIV pre-exposure prophylaxis (PrEP) when prescribed by a specialist, typically preceded by a general practitioner’s (GP) referral. The GP perspective with regard to PrEP implementation in Norway has yet to be captured.
Subject and methods
We explored PrEP knowledge, attitudes, and clinical experience of GPs in the Norwegian capital of Oslo, where HIV incidence and PrEP demand are highest. An anonymous survey was designed and distributed between November 2019 and February 2020. Univariate and multivariate logistic regression analyses were performed to identify determinants of GPs’ previous clinical PrEP experience (PrEP adoption).
Results
One hundred and seventeen GPs responded to the survey. GP PrEP adopters were more likely to: identify as men (aOR 2.1; 95% CI: 1.0–4.5); identify as lesbian, gay, or bisexual (LGB) (aOR 4.4; 95% CI: 1.4–14.5); have ≥ 10 LGB identifying patients on their list (aOR 4.4; 95% CI:1.8–10.4); and self-report higher levels of PrEP knowledge (aOR 2.4; 95% CI: 1.3–4.4).
Conclusion
Our findings suggest that GP PrEP knowledge is crucial to patient PrEP access. Educational interventions ought to be considered to enhance GP PrEP adoption capacities, such as easy-to-access PrEP guidelines and peer-based training opportunities in both online and in-person formats.
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9
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Rosengren AL, Lelutiu-Weinberger C, Woodhouse EW, Sandanapitchai P, Hightow-Weidman LB. A Scoping Review of HIV Pre-exposure Prophylaxis Stigma and Implications for Stigma-Reduction Interventions for Men and Transwomen Who Have Sex with Men. AIDS Behav 2021; 25:2054-2070. [PMID: 33389319 PMCID: PMC10539076 DOI: 10.1007/s10461-020-03135-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/31/2022]
Abstract
HIV remains a public health concern in the United States. Although pre-exposure prophylaxis (PrEP) can be expected to reduce HIV incidence, its uptake, adherence, and persistence remain limited, particularly among highest priority groups such as men who have sex with men and transwomen (MSMTW). Using a socioecological framework, we conducted a scoping review to examine PrEP-related stigma to inform future research, policy, and programmatic planning. Using the PRISMA extension for scoping reviews, we conducted database searches from August 2018 to April 2020 for articles addressing PrEP stigma. Studies were independently screened and coded by three authors, resulting in thematic categorization of several types of PrEP stigma on four socioecological levels. Of 557 references, a final sample of 23 studies was coded, 61% qualitative, and 87% focusing exclusively on MSMTW. Most instances of PrEP-related stigma occurred on the interpersonal level and included associations of PrEP with risk promotion, HIV-related stigma, and promiscuity. Other frequent themes across socioecological levels included provider distrust and discrimination, government and pharmaceutical industry distrust, internalized homonegativity, PrEP efficacy distrust, and anticipated homonegativity. Notably, PrEP was also framed positively as having physical and psychological benefits, and assuming responsibility for protecting one's community via PrEP awareness-raising. PrEP-related stigma persists, demanding interventions to modify its impact. Leveraging PrEP-positive discourses to challenge PrEP stigma is an emerging avenue, alongside efforts to increase provider willingness to promote PrEP routinely by reducing provider bias, aligning with the national strategy to End the HIV Epidemic.
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Affiliation(s)
- A Lina Rosengren
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
| | - Corina Lelutiu-Weinberger
- Rutgers Biomedical and Health Sciences, School of Nursing, François-Xavier Bagnoud Center, Rutgers University, 65 Bergen Street, Room 846N, Newark, NJ, 07107, USA
| | - E Wilbur Woodhouse
- Department of Medicine, Vanderbilt University Medical center, 1161 21st Avenue South, Nashville, TN, 37122, USA
| | | | - Lisa B Hightow-Weidman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
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Cui S, Ding H, Huang X, Wang H, Tang W, Leuba SI, Ye Z, Jiang Y, Geng W, Xu J, Shang H. Factors Influencing Clinicians' Willingness to Prescribe Pre-exposure Prophylaxis for Persons at High Risk of HIV in China: Cross-sectional Online Survey Study. JMIR Public Health Surveill 2021; 7:e24235. [PMID: 34085941 PMCID: PMC8214180 DOI: 10.2196/24235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/13/2020] [Accepted: 04/15/2021] [Indexed: 02/06/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective HIV prevention measure. Clinicians play a crucial role in PrEP implementation, and their knowledge, attitudes, and career experience may affect their willingness to prescribe PrEP. However, little is known about the attitudes and willingness of clinicians to prescribe PrEP in countries without PrEP-specific guidelines. Objective We aimed to determine the factors associated with clinicians being willing to prescribe PrEP in China. Methods Between May and June 2019, we conducted an online cross-sectional survey of clinicians in 31 provinces across the six administrative regions in China on the WeChat smartphone app platform. Multivariable logistic regression was used to determine factors associated with willingness to prescribe PrEP. Results Overall, 777 HIV clinicians completed the survey. Most of the respondents had heard of PrEP (563/777, 72.5%), 31.9% (248/777) thought that PrEP was extremely effective for reducing the risk of HIV infection, and 47.2% (367/777) thought that it was necessary to provide PrEP to high-risk groups. After adjusting for age, gender, ethnicity, and educational background of the clinicians, the following factors significantly increased the odds of the clinicians being willing to prescribe PrEP: having worked for more than 10 years, compared to 5 years or less (adjusted odds ratio [aOR] 2.82, 95% CI 1.96-4.05); having treated more than 100 patients living with HIV per month, compared to 50 patients or fewer (aOR 4.16, 95% CI 2.85-6.08); and having heard of PrEP (aOR 7.32, 95% CI 4.88-10.97). Clinicians were less likely to be willing to prescribe PrEP if they were concerned about poor adherence to PrEP (aOR 0.66, 95% CI 0.50-0.88), the lack of PrEP clinical guidelines (aOR 0.47, 95% CI 0.32-0.70), and the lack of drug indications for PrEP (aOR 0.49, 95% CI 0.32-0.76). Conclusions About half of all clinicians surveyed were willing to prescribe PrEP, but most surveyed had a low understanding of PrEP. Lack of PrEP clinical guidelines, lack of drug indications, and less than 11 years of work experience were the main barriers to the surveyed clinicians’ willingness to prescribe PrEP. Development of PrEP clinical guidelines and drug indications, as well as increasing the availability of PrEP training, could help improve understanding of PrEP among clinicians and, thus, increase the number willing to prescribe PrEP.
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Affiliation(s)
- Sitong Cui
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Shenzhen Third People's Hospital, Shenzhen, China
| | - Weiming Tang
- Project-China, University of North Carolina at Chapel Hill, Guangzhou, China
| | - Sequoia I Leuba
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zehao Ye
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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11
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Przybyla S, Fillo J, Kamper-DeMarco K, Bleasdale J, Parks K, Klasko-Foster L, Morse D. HIV pre-exposure prophylaxis (PrEP) knowledge, familiarity, and attitudes among United States healthcare professional students: A cross-sectional study. Prev Med Rep 2021; 22:101334. [PMID: 33680721 PMCID: PMC7930580 DOI: 10.1016/j.pmedr.2021.101334] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/24/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
The United States' initiative to End the HIV Epidemic by 2030 includes a primary goal to reduce new HIV infections by 90 percent. One key contributor to this plan is HIV pre-exposure prophylaxis (PrEP). While knowledge and acceptance of PrEP among clinicians is growing, few studies have assessed knowledge and awareness among future healthcare professionals in academic training programs. The present study aimed to assess and compare healthcare trainees' awareness, knowledge, and familiarity with PrEP prescribing guidelines to better understand and prevent gaps in academic training regarding PrEP. A cross-sectional web-based survey of medical, nurse practitioner, and pharmacy students enrolled at two universities was conducted between October 2017 and January 2018. The study assessed participants' awareness, knowledge, and familiarity with PrEP prescribing guidelines and willingness to prescribe PrEP and refer to another healthcare provider. The survey was completed by 744 participants (response rate = 36.2%). Overall, PrEP awareness was high though PrEP knowledge was low. There were significant differences among student groups in domains of interest. Pharmacy students had the greatest PrEP knowledge, awareness, and familiarity with prescribing guidelines. However, medical students reported the greatest comfort with performing PrEP-related clinical activities and willingness to refer a candidate to another provider. Study findings enhance our understanding of healthcare professional students' perspectives of PrEP as a biomedical prevention strategy for HIV. The gaps in students' knowledge offer opportunities for the development of educational strategies to support HIV prevention among future healthcare professionals.
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Affiliation(s)
- Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Corresponding author at: Director of Undergraduate Public Health Programs, University at Buffalo School of Public Health and Health Professions, 3435 Main Street, 305 Kimball Tower, United States.
| | - Jennifer Fillo
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, United States
| | | | - Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Kathleen Parks
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Lynne Klasko-Foster
- Department of Psychology and Human Behavior, William Alpert Medical School, Brown University, Providence, RI, United States
- Center for Health Equity Research, School of Public Health, Brown University, Providence, RI, United States
| | - Diane Morse
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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12
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Tam G, Wong NS, Lee SS. A survey of the involvement of primary care doctors in HIV prevention and care in a low-prevalence, high-income setting. BMC FAMILY PRACTICE 2021; 22:27. [PMID: 33504326 PMCID: PMC7842046 DOI: 10.1186/s12875-021-01376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND In high-income countries with a low HIV prevalence, primary care doctors are likely the first point of medical contact for people at high risk of HIV. One of the key factors for successful implementation of preventive measures is the cooperation of primary healthcare providers. Hong Kong's population mostly seek primary care in the private sectors. Our study evaluated the involvement of private primary healthcare providers in HIV prevention and care. METHODS A cross-sectional postal structured questionnaire was administered to 1102 private primary care doctors in Hong Kong in December 2017. Responses were received via postal mail, fax or online. Non-respondents received a phone-call reminder to complete the survey. Descriptive analyses were performed for all the question items. Chi-square test was used to assess the association between participants' level of involvement in HIV prevention and care and their demographics and medical practice characteristics. RESULTS The response rate was 17.9% (197/1102). Most of the respondents were Chinese (95%) and have obtained their primary medical qualifications in Hong Kong (72%). More than half of the doctors have practiced in the private sector for more than 20 years (54%). Six aspects were used to evaluate practices or involvements in HIV prevention or care: Most of the responding doctors had offered advice (61%) and/or HIV test (76%) to patients with high-risk behaviors. However, fewer doctors had diagnosed HIV (27%), provided care for HIV positive patients (21%), reported HIV cases (19%) or prescribed antiretrovirals (4%). Nine (4.5%) did not answer all six questions on their practices or involvements in HIV prevention or care. The remaining respondents were then categorized into no/low involvement group and high involvement group. Overall,71% had no/low involvement (133/188) compared to 29% who had high involvement (55/188). Factors associated with high involvement included being in the 50-59 age group (OR: 2.48, 95% CI: 1.12-5.5), and belonging to a large practice (OR: 3.16, 95% CI: 1.4-7.12). CONCLUSIONS Overall, most private primary care doctors in Hong Kong have no or low involvement in HIV prevention and care. However, most were willing and experienced in providing general preventive services, such as HIV testing and advice.
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Affiliation(s)
- Greta Tam
- School of Public Health, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, 204-208 Postgraduate Education Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, 204-208 Postgraduate Education Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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13
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Hillis A, Germain J, Hibbert MP, Hope V, Van Hout MC. "Belt and braces approach; added benefit and … extra reassurance": a multi-stakeholder examination of the challenges to effective provision of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Northern and Central England. AIDS Care 2021; 33:736-745. [PMID: 33443448 DOI: 10.1080/09540121.2021.1871721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pre-exposure prophylaxis (PrEP) involves HIV negative individuals taking antiretroviral drugs to reduce the probability of infection if exposed and is available through the IMPACT trial in England. This study aimed to explore men who have sex with men (MSM) and service provider (SP) perspectives on provision and accessibility of PrEP in Northern and Central England. Twenty MSM and 25 SPs from four Northern cities and one city in the West Midlands region were recruited for semi-structured interviews (December 2018 to October 2019). Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Three key themes emerged: "Self-sourcing PrEP"; "Service delivery learnings"; and "Impact of using PrEP". Problems with equity of access and accessibility were noted, and recommendations for the future of PrEP programming and equitable service delivery were also presented. The study highlighted divergence in PrEP service experience from patients and providers, with results informing policy, practice and professional training.
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Affiliation(s)
- Alyson Hillis
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Jennifer Germain
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | | | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
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14
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Shamu S, Shamu P, Khupakonke S, Farirai T, Chidarikire T, Guloba G, Nkhwashu N. Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts. Glob Health Action 2021; 14:1886455. [PMID: 33606603 PMCID: PMC7899653 DOI: 10.1080/16549716.2021.1886455] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing HIV incidence. However, more evidence of PrEP knowledge, willingness and distribution preferences is required for scale-up among young people at-risk. Objective: To understand young people PrEP awareness, willingness and roll-out preferences. Methods: Young people (18-24y) were selected through multi-stage sampling in a cross-sectional household survey in low-income communities. Self-administered interviews collected participants' data about PrEP awareness, attitudes, willingness and HIV-risk practices. Data were descriptively analysed by gender. Regression models assessed factors associated with PrEP awareness and willingness by district. Results: Of the 1917 participants interviewed 44.6% (men = 39.4% vs women = 49%, p = 0.001) were PrEP aware, 49.0% were willing to use PrEP. Participants most preferred PrEP distribution channels were public clinics (51.2%) and hospitals (23.8%). More men than women preferred distribution through schools (11.9% vs7.8%; p = 0.002) and NGOs (8.5%vs5.4%; p = 0.008). The biggest barrier to PrEP willingness was inadequate PrEP knowledge (10.0%) but more men than women disliked taking pills daily (4.1%vs2.0%; p-value = 0.007). Gendered determinants to use PrEP were side effects (51%; men = 47% vs women = 55%; p = 0.001) and pill effectiveness (29.5%; men = 26.4% vs women = 32.6%; p = 0.003). In both districts PrEP knowledge was associated with being female and media use. The associations between PrEP awareness and having multiple sexual partnerships, HIV knowledge, HIV self-test willingness and belonging to social clubs differed by district. PrEP willingness was positively associated with having TB and PrEP knowledge in each district but district differences were observed in media and occupation factors. Conclusions: The study shows young people's low levels of PrEP awareness. It also shows relatively increased willingness, gendered PrEP awareness and distribution preferences. Promoting youth's PrEP awareness requires a multifarious media strategy. Abbreviations: HIV: human immunodeficiency virus; AIDS: Acquired immunodeficiency syndrome; aOR: Adjusted Odds ratio; PLWH: People living with HIV; PrEP: Pre-exposure Prophylaxis; UNAIDS: Joint United Nations Programme on HIV and AIDS; uOR: Unadjusted odds ratio; TB: Tuberculosis; WHO: World health Organisation; MSM: Men who have sex with men.
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Affiliation(s)
- Simukai Shamu
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Shamu
- Wits Health Research Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Sikhulile Khupakonke
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
| | - Thato Farirai
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
| | - Thato Chidarikire
- HIV, AIDS and STIs Cluster, National Department of Health, Pretoria, South Africa
| | - Geoffrey Guloba
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
| | - Nkhensani Nkhwashu
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
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15
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Bunting SR, Garber SS, Goldstein RH, Calabrese SK, Ritchie TD, Batteson TJ. Health Profession Students' Awareness, Knowledge, and Confidence Regarding Preexposure Prophylaxis: Results of a National, Multidisciplinary Survey. Sex Transm Dis 2021; 48:25-31. [PMID: 32810029 DOI: 10.1097/olq.0000000000001263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) is a highly effective, pharmacologic method of HIV prevention. Despite its safety and efficacy, PrEP prescription remains low in those patients who are at highest risk for HIV infection. One possible reason for this may be the lack of inclusion of PrEP and HIV prevention discussions within the curricula of health professions education. METHODS An online survey was administered to a cross-sectional sample of future prescribers (osteopathic/allopathic medical and physician assistant students), future nurses, and future pharmacists (n = 2085) in the United States between January and July 2019 to assess and compare awareness of PrEP, PrEP education, PrEP knowledge, and confidence in 2 areas related to PrEP. RESULTS We show that, overall, awareness of PrEP is high among future health care providers (81.6%), with the future pharmacists reporting the greatest awareness (92.2%; P < 0.001) and more commonly reporting PrEP education (71.0%). Students had mixed knowledge of PrEP, with future pharmacists reporting the highest knowledge of PrEP. Approximately 30% of students in all disciplines reported having low confidence counseling a patient about PrEP and low confidence educating a colleague about PrEP. Knowledge of PrEP was a significant predictor of confidence counseling a patient about PrEP (P < 0.001) and educating a colleague about PrEP (P < 0.001). CONCLUSIONS This study identifies opportunities to improve and incorporate evidence-based strategies for educating future health care providers about PrEP for HIV prevention within health professions curricula.
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Affiliation(s)
| | - Sarah S Garber
- Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Robert H Goldstein
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
| | | | - Tamzin J Batteson
- DeWitt C. Baldwin Institute for Interprofessional Education, Rosalind Franklin University of Medicine and Science, North Chicago, IL
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16
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Cerqueira NB, Vasconcelos R, Hojilla JC, Kallás EG, Avelino-Silva VI. Attitudes and Knowledge About Human Immunodeficiency Virus Pre-Exposure Prophylaxis Among Brazilian Infectious Disease Physicians. AIDS Res Hum Retroviruses 2020; 36:1047-1053. [PMID: 32657136 DOI: 10.1089/aid.2019.0281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The objective was to describe levels and predictors of knowledge, attitudes, and willingness to prescribe pre-exposure prophylaxis (PrEP) among Brazilian Infectious Disease (ID) Physicians. The design was a cross-sectional study. We collected information on demographics and attitudes/knowledge about PrEP using an anonymous electronic survey. Willingness to prescribe PrEP, fear of adherence issues, and concerns about risk compensation were addressed in three case vignettes that varied by a single characteristic (i.e., by gender identity, drug use, and socioeconomic status) randomly assigned to physicians. Three hundred seventy ID physicians responded to the survey. Although most identified as informed/well informed about PrEP (75%) and believed PrEP availability to be necessary (38%), concerns with adherence (49%), side effects (38%), risk compensation (28%), and increase in sexually transmitted infection incidence (38%) were raised. We found no statistically significant differences in willingness to prescribe PrEP and concerns around risk compensation across the three case vignettes. ID physicians who declared having a religion reported more concerns about risk compensation compared to those self-identified as atheists (72% vs. 46%, p < .001). Most Brazilian ID physicians reported a positive attitude toward PrEP. Patients' gender identity, drug use, and socioeconomic status were not associated with willingness to prescribe PrEP. However, ID physicians who declared having a religion were more frequently concerned about risk compensation among PrEP users, suggesting that personal beliefs can influence PrEP implementation.
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Affiliation(s)
- Natália Barros Cerqueira
- Department of Infectious and Parasitic Diseases, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ricardo Vasconcelos
- Department of Infectious and Parasitic Diseases, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - J. Carlo Hojilla
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Esper Georges Kallás
- Department of Infectious and Parasitic Diseases, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Vivian I. Avelino-Silva
- Department of Infectious and Parasitic Diseases, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
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17
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MIRZAEI-ALAVIJEH MEHDI, JALILIAN FARZAD, MOTLAGH MOHAMMADESMAIEL, SAADATFAR ABDOLLAH, FATTAHI MOHHAMAD. HIV/AIDS knowledge among Iranian Health Care Workers. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E386-E391. [PMID: 33150227 PMCID: PMC7595077 DOI: 10.15167/2421-4248/jpmh2020.61.3.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Abstract
Background HIV/AIDS remains a major public health concern globally and Health Care Workers (HCWs) are in the frontline of preventing and providing care in the health care system. The aim of this study was to evaluate HIV/AIDS knowledge among Iranian HCWs. Methodology This cross-sectional study was conducted among 200 HCWs who were randomly selected from health care centers in Kermanshah city, west of Iran, 2018. HCWs filled out a self-administered questionnaire including the socio-demographic characteristics and HIV/AIDS knowledge items. Data were analyzed by SPSS version 16 using bivariate correlations, t-test, and ANOVA statistical tests. Results The mean score of HIV/AIDS knowledge was 29.73 [95% CI: 28.79, 30.67], ranged from 0 to 40 (74.3% of total percent). There was no significant association and correlation between HIV/AIDS knowledge and sex, education level, marital status, age and job history. Up to 50% had inadequate knowledge about HIV/AIDS status and transmission in Iran. Conclusions HCWs HIV/AIDS knowledge was average and it seems need to be educating regarding HIV/AIDS status and transmission in Iran.
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Affiliation(s)
- MEHDI MIRZAEI-ALAVIJEH
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - FARZAD JALILIAN
- Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Correspondence: Farzad Jalilian, Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran, 67198-51351 - Tel (Fax). +988338263048 -
| | - MOHAMMAD ESMAIEL MOTLAGH
- Department of Pediatrics, Faculty Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - ABDOLLAH SAADATFAR
- Department of Urology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MOHHAMAD FATTAHI
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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18
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Cimen C, Emecen AN, Barber TJ. Attitude of infectious diseases physicians in Turkey about HIV pre-exposure prophylaxis: results of an online survey. Int J STD AIDS 2020; 31:665-670. [PMID: 32538328 DOI: 10.1177/0956462420921080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is the provision of antiretroviral drugs before HIV exposure to prevent infection for those in whom it is indicated. We conducted an online survey about PrEP in a national sample of infectious diseases physicians in Turkey. They were surveyed from March to April 2019 and they were asked about their attitudes, knowledge and clinical practise about PrEP. Overall, 209 of 2100 (10%) completed the survey, of whom 66.3% were female, 69.5% were specialist and 41.1% were working at education and research hospitals. Most of the participants reported their PrEP knowledge as 'low'. Men who have sex with men was the most suitable group for PrEP according to participants. 27.9% of them were requested to prescribe PrEP which was to be paid by individuals themselves and 24.2% of the participants had recommended PrEP in their clinical practice. The primary concerns among those who would not recommend PrEP were the possible increase in sexually transmitted infections, the potential low cost-effectiveness of PrEP, the ineffectiveness of PrEP in HIV transmission and the time lost to following-up the individuals taking PrEP. Developing a national guideline would support clinicians in order to change their attitudes and to find answers to their concerns.
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Affiliation(s)
- Cansu Cimen
- Infectious Diseases and Clinical Microbiology Clinic, Ardahan State Hospital, Ardahan, Turkey
| | - Ahmet N Emecen
- Department of Public Health, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Tristan J Barber
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, London, UK
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19
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Bunting SR, Garber SS, Goldstein RH, Ritchie TD, Batteson TJ, Keyes TJ. Student Education About Pre-exposure Prophylaxis (PrEP) Varies Between Regions of the United States. J Gen Intern Med 2020; 35:2873-2881. [PMID: 32080792 PMCID: PMC7573046 DOI: 10.1007/s11606-020-05736-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Daily, oral pre-exposure prophylaxis (PrEP) is an effective and safe prevention strategy for people at risk for HIV. However, prescription of PrEP has been limited for patients at the highest risk. Disparities in PrEP prescription are pronounced among racial and gender minority patients. A significant body of literature indicates that practicing healthcare providers have little awareness and knowledge of PrEP. Very little work has investigated the education about PrEP among health professionals in training. OBJECTIVE The objective of this study was to compare health professions students' awareness of PrEP and education about PrEP between regions of the US, and to determine if correlations between regional HIV incidence and PrEP use were present. DESIGN Survey study. PARTICIPANTS A cross-sectional sample of health professions students (N = 1859) representing future prescribers (MD, DO, PA), pharmacists, and nurses in the US. KEY RESULTS Overall, 83.4% of students were aware of PrEP, but only 62.2% of fourth-year students indicated they had been taught about PrEP at any time during their training. Education about PrEP was most comprehensive in the Northeastern US, the area with the highest PrEP to need ratio (4.7). In all regions, transgender patients and heterosexual men and women were least likely to be presented in education as PrEP candidates, and men who have sex with men were the most frequently presented. CONCLUSIONS There are marked differences in education regarding PrEP both between academic programs and regions of the USA.
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Affiliation(s)
- Samuel R Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
| | - Sarah S Garber
- Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Robert H Goldstein
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Tamzin J Batteson
- DeWitt C. Baldwin Institute for Interprofessional Education, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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20
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Plomer AS, McCool-Myers M, Apfelbacher C. Perspectives on HIV PrEP care in Germany: qualitative insights from primary care physicians and specialists. AIDS Care 2020; 32:994-1000. [PMID: 32539453 DOI: 10.1080/09540121.2020.1778626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recently, research has shifted from investigating the effectiveness of HIV pre-exposure prophylaxis (PrEP) to strategizing its implementation. Several European studies have explored physicians' perspectives on implementing PrEP in diverse settings, yet there are no data on the situation in Germany. The purpose of this study was to explore physicians' perspectives on current PrEP care in Germany. From April to July 2018, we conducted 16 semi-structured interviews with HIV providers (HIVPs) and primary care physicians (PCPs). Transcripts were analyzed using thematic content analysis. Physicians showed varying levels of PrEP expertise. Many PCPs lacked knowledge about PrEP. Some PCPs did not support the idea of PrEP as a prophylactic option. Opinions about PCPs' role in PrEP care were diverging, yet most PCPs favored referring PrEP clients to an HIVP or opted for a shared-care arrangement. Perceived problems included stigma and lack of privacy for PrEP care in rural areas. Our findings highlight the need for tailored physician training, which should be addressed in PrEP implementation in Germany.
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Affiliation(s)
- Anna-Sophie Plomer
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University, Atlanta, GA, USA
| | - Christian Apfelbacher
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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21
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Development of a 10-Item Tool to Identify Advanced Practice Nurse Readiness to Prescribe Pre-exposure Prophylaxis. J Assoc Nurses AIDS Care 2020; 30:312-320. [PMID: 31026240 DOI: 10.1097/jnc.0000000000000038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pre-exposure prophylaxis (PrEP), a biomedical tool to prevent the acquisition of HIV, reduces the risk of HIV in high-risk individuals by more than 90%. An online questionnaire was fielded from March 2017 to May 2017 to a random sample of licensed advanced practice nurses (APNs) from the U.S. state of Indiana. Discriminant function analysis was performed to reveal willingness to prescribe PrEP. Two discriminant functions were identified: Sexual Risk Assessment (r = .686), PrEP Barriers (r = .587), Evidence-Based Practice Implementation (r = .545), Community Awareness (r = .446), Perceived Risk (r = .356), and Organizational Climate (r = .346) were loaded on the first function, whereas PrEP Skills (r = .837) was loaded on the second function. The results suggest APN's willingness to learn and knowledge about PrEP-influenced implementation. Findings demonstrated that readiness to prescribe PrEP by APNs in Indiana could be predicted with a high level of certainty using identified variables.
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22
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Lazarou M, Fitzgerald L, Warner M, Downing S, Williams OD, Gilks CF, Russell D, Dean JA. Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study. Sex Health 2020; 17:485-492. [PMID: 33292927 DOI: 10.1071/sh20156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022]
Abstract
Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers' (HCP) knowledge and preparedness to prescribe PrEP remains limited. METHODS Semistructured interviews, conducted before PBS listing (October 2016-April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. RESULTS Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia's universal healthcare insurance system). CONCLUSIONS Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.
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Affiliation(s)
- Mattea Lazarou
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Melissa Warner
- Blood Borne Virus and Sexually Transmissible Infection Unit, Communicable Disease Branch, Queensland Health, Butterfield Street, Herston, Qld 4006, Australia
| | - Sandra Downing
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Douglas, Qld 4811, Australia
| | - Owain D Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Charles F Gilks
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, 381 Sheridan Street, Cairns North, Qld 4870, Australia; and College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Qld 4811, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia; and Corresponding author.
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Reyniers T, Vuylsteke B, Pirotte B, Hoornenborg E, Bil JP, Wouters K, Laga M, Nöstlinger C. Physicians' preparedness for pre-exposure prophylaxis: results of an online survey in Belgium. Sex Health 2019; 15:606-611. [PMID: 30384876 DOI: 10.1071/sh18072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/27/2018] [Indexed: 12/21/2022]
Abstract
Background Physicians have a crucial role in the implementation and scale up of pre-exposure prophylaxis (PrEP). The objective of this study is to examine Belgian physicians' PrEP knowledge, concerns, acceptance and their willingness to prescribe PrEP. METHODS A cross-sectional online survey was conducted between March and June 2016. Dissemination targeted Belgian primary care physicians (PCPs) and HIV specialists. Sociodemographic characteristics, experience with HIV and PrEP, self-assessed PrEP knowledge, concerns about PrEP, and PrEP acceptance were stratified according to professional background. Associations with willingness to prescribe PrEP were examined using univariable and multivariable binary logistic regression analyses. RESULTS In total, 333 completed surveys were included in the analysis. Sixty-two physicians (18.6%) scored their knowledge of PrEP to be good, 263 (79.0%) had an accepting attitude towards PrEP and 198 (59.5%) were willing to prescribe PrEP if approved in Belgium. HIV specialists consistently reported having better knowledge of PrEP, less concerns and a more accepting attitude towards PrEP than PCPs. In multivariable logistic regression analysis, higher PrEP knowledge (OR 2.4; 95%CI: 1.0-5.7) and higher PrEP acceptance (OR: 3.8; 95%CI: 2.1-6.8) remained significantly associated with the willingness to prescribe PrEP. CONCLUSIONS HIV specialists are better prepared to provide PrEP than PCPs in Belgium. Interventions to improve PrEP knowledge and acceptance among all providers are needed. The role of PCPs could be very important in optimising the rollout of PrEP, but additional training and guidelines will be needed.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Benoit Pirotte
- Department of Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, Boulevard du Douzième de Ligne 1, 4000 Liège, Belgium
| | - Elske Hoornenborg
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands
| | - Janneke P Bil
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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24
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Rice WS, Stringer KL, Sohail M, Crockett KB, Atkins GC, Kudroff K, Batey DS, Hicks J, Turan JM, Mugavero MJ, Turan B. Accessing Pre-exposure Prophylaxis (PrEP): Perceptions of Current and Potential PrEP Users in Birmingham, Alabama. AIDS Behav 2019; 23:2966-2979. [PMID: 31297683 DOI: 10.1007/s10461-019-02591-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Limited studies to date assess barriers to and facilitators of PrEP uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. We examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama. Participants were 32 years old on average, 66% Black, 66% gay or lesbian, 70% male, and 66% single. Perceived barriers to PrEP access included: lack of PrEP awareness and advertisement; sexuality-related stigma; time and resource constraints; and concerns about the adequacy and technical quality of PrEP services. Perceived facilitators to PrEP access were: PrEP-related information gathering and sharing; increased dialogue and visibility around PrEP; social, programmatic, and clinical support; and, lastly, self-preservation; personal motivation; and treatment self-efficacy. Results point to opportunities to address complex barriers to equitable PrEP access using multilevel and multimodal solutions.
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Affiliation(s)
- Whitney S Rice
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 538, Atlanta, GA, 30322, USA.
| | - Kristi L Stringer
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Maira Sohail
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaylee B Crockett
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ghislaine C Atkins
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kachina Kudroff
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Kundu I, Martinez-Donate A, Karkada N, Roth A, Felsher M, Sandling M, Szep Z. Attitudes and referral practices for pre-exposure prophylaxis (PrEP) among HIV rapid testers and case managers in Philadelphia: A mixed methods study. PLoS One 2019; 14:e0223486. [PMID: 31589632 PMCID: PMC6779237 DOI: 10.1371/journal.pone.0223486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Adoption of pre-exposure prophylaxis (PrEP) to prevent HIV infection has been slow. The purpose of this study was to evaluate knowledge, attitudes and referral practices for PrEP among non-prescribing providers, who may play key role. Methods We performed a cross-sectional survey on PrEP knowledge, attitudes, and referral practices among 66 non-prescribing HIV prevention providers (1st August to 31st December, 2016), in Philadelphia, followed by qualitative interviews with 12 of them (5th April to 10th May, 2017). Results Participants had a mean age of 36 years, with 62% females. Majority were HIV case managers and rapid testers. For half of the respondents, PrEP eligibility screening was part of rapid HIV testing at their organization, 40% never had PrEP training and only 27% indicated personally screening clients for eligibility. Qualitative data revealed that participants held positive attitudes about PrEP and perceived organizational support, but had concerns about potential negative impacts and barriers to routine HIV screening. Conclusion Results highlight the importance of training non-prescribing HIV prevention providers about PrEP, addressing their concerns, and incorporating PrEP screening and referral into routine HIV testing.
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Affiliation(s)
- Iman Kundu
- Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
- * E-mail:
| | - Ana Martinez-Donate
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
| | - Navya Karkada
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
| | - Alexis Roth
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
| | - Marisa Felsher
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
| | - Marcus Sandling
- Department of Medicine, Division of Infectious Diseases & HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Zsofia Szep
- Department of Medicine, Division of Infectious Diseases & HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, United States of America
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Przybyla SM, Parks K, Bleasdale J, Sawyer J, Morse D. Awareness, knowledge, and attitudes towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among pharmacy students. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:352-360. [PMID: 31040011 PMCID: PMC6800069 DOI: 10.1016/j.cptl.2019.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/26/2018] [Accepted: 01/05/2019] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The purpose of this study was to assess pharmacy students' awareness, knowledge, and perceptions towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), confidence and intentions to counsel patients on PrEP, and preferred PrEP training. METHODS A web-based cross-sectional survey was conducted with pharmacy students. Descriptive statistics and multivariate logistic regressions were performed. RESULTS Ninety-one percent of participants were aware of PrEP and 61% were familiar with PrEP prescription guidelines. In multivariate analysis, greater PrEP knowledge, attitudes towards PrEP, and familiarity with prescribing guidelines were significantly associated with confidence in PrEP counseling (p < 0.01 for all). Males had significantly higher odds of reporting confidence in PrEP counseling relative to their female counterparts (p < 0.01). Relative to fourth year students, second year students were less likely to report confidence in PrEP counseling (p < 0.01). Participants who were familiar with prescribing guidelines had significantly higher odds of PrEP counseling intentions (p < 0.05). Preferred educational topics regarding PrEP included training on side effects and adherence monitoring (65% and 51%, respectively). The most preferred modalities for receiving PrEP education were online education (47%), educational seminars in required courses (43%), and self-study modules (39%). CONCLUSIONS Given the key role played by pharmacists in patient engagement, they may be presented with opportunities to provide PrEP counseling and education. The development of educational modules for pharmacy students in an effort to increase PrEP uptake should consider addressing gaps in knowledge and preferred training modalities.
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Affiliation(s)
- Sarahmona M Przybyla
- University at Buffalo School of Public Health and Health Professions, 3435 Main Street, 305 Kimball Tower, Buffalo, NY 14214, United States.
| | - Kathleen Parks
- University at Buffalo Clinical and Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States.
| | - Jacob Bleasdale
- University at Buffalo School of Public Health and Health Professions, 3435 Main Street, 320 Kimball Tower, Buffalo, NY 14214, United States.
| | - Joshua Sawyer
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 701 Ellicott Street, Room B2-139, Buffalo, NY 14203, United States.
| | - Diane Morse
- University of Rochester School of Medicine and Dentistry, 2613 West Henrietta Road, Rochester, NY 14623, United States.
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27
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Glove Perforation in Orthopaedics: Probability of Tearing Gloves During High-Risk Events in Trauma Surgery. J Orthop Trauma 2018; 32:474-479. [PMID: 29889823 DOI: 10.1097/bot.0000000000001233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the risk of glove perforation during common maneuvers or events in trauma-related orthopaedic surgical procedures. METHODS Four investigators executed 6 high-risk maneuvers in a simulated laboratory setting. Alternative techniques were also performed for most maneuvers. Glove integrity was examined by 2 standard methods of fluid leak testing. The rates of perforation were compared between techniques using χ and Fisher exact tests. RESULTS Investigators were only able to identify 14.3% of perforations. Cleaning drill bit flutes by hand had the highest overall tear rate (85%). Catching a glove along the guide wire when passing a cannulated drill bit resulted in a 50% perforation rate. Catching a glove around a rotating drill shaft had a tear rate of 40%. Palpating the end of a flexible nail cut with a wire cutter had a significantly higher perforation rate than a nail cut with a proprietary, nail-specific tool (35% vs. 5%, P = 0.022). Blind digital fracture reduction had a tear rate that was not statistically different than directly visualizing the reduction (20% vs. 15%, P = 0.5). Inserting screws while stabilizing the threads with one's fingers resulted in a perforation rate of 15%. CONCLUSIONS Orthopaedic surgeons should be aware that microperforation of surgical gloves often goes undetected and should consider modifying or using alternative techniques when performing certain surgical maneuvers. The results of this study can be used by orthopaedic and surgical first assist training programs to promote safe surgical practice.
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28
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Support for PrEP Among New Jersey Health Care Workers. J Assoc Nurses AIDS Care 2018; 29:849-857. [PMID: 30369414 DOI: 10.1016/j.jana.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023]
Abstract
We used an online survey of health care workers in New Jersey to assess awareness, perceptions, and support of preexposure prophylaxis (PrEP). We sampled respondents from diverse health care worker occupations, in HIV and non-HIV care settings. Of 174 participants, awareness of PrEP was high at 91% (n = 122), as was support for its use by members of at-risk groups (74%). Occupation was the only independent variable with significant variation in support of PrEP, with 41% of disease intervention specialists/health educators supporting PrEP completely, compared with 93% of nurses. Concerns that poor adherence could lead to resistant strains of HIV and that use could lead to "irresponsible sexual activity" were the most commonly endorsed barriers to PrEP support. The study suggests that, despite high levels of PrEP awareness, targeted education activities are needed to support New Jersey's efforts to expand PrEP availability and use.
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29
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Zablotska IB, O'Connor CC. Preexposure Prophylaxis of HIV Infection: the Role of Clinical Practices in Ending the HIV Epidemic. Curr HIV/AIDS Rep 2018; 14:201-210. [PMID: 29071519 DOI: 10.1007/s11904-017-0367-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to summarise the recent evidence from high-income settings about providers' ability to deliver on the UNAIDS goal of at least three million people at substantial risk of HIV infection with PrEP by 2020, including awareness and knowledge about PrEP, willingness to prescribe PrEP, current levels of prescribing and service delivery models and issues. RECENT FINDINGS Awareness about PrEP among health providers is growing, but at different pace depending on provider type. HIV and sexual health specialists are more likely to have knowledge about PrEP than generalists, and to be willing to prescribe it, mainly because of their closer contact with people at high risk for HIV and better risk assessment skills. There is still no consensus as to who should be responsible for providing PrEP, but clearly all hands on deck will be useful in delivering on the international target of three million people at substantial risk for HIV on PrEP by 2020. Only about 5% of the target has been reached so far. Local guidance and large-scale education and information programs for clinicians will be necessary to upskill health providers. High cost of PrEP is still a major barrier for its broad implementation, even in countries were PrEP roll-out has started. Health services are facing major structural challenges due to implementation of PrEP services to a substantial volume of patients. The early implementation experiences demonstrated that PrEP can be successfully delivered across a variety of settings, and a broad range of strategies and models of care can streamline PrEP delivery. Education of the providers and PrEP cost solutions will be essential for rapid roll-out of PrEP.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia.
| | - Catherine C O'Connor
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia
- Sexual Health Service, Sydney Local Health District, Camperdown, 2050, Australia
- Central Clinical School, University of Sydney, Sydney, 2006, Australia
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30
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Beymer MR, DeVost MA, Weiss RE, Dierst-Davies R, Shover CL, Landovitz RJ, Beniasians C, Talan AJ, Flynn RP, Krysiak R, McLaughlin K, Bolan RK. Does HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, California. Sex Transm Infect 2018; 94:457-462. [PMID: 29487172 DOI: 10.1136/sextrans-2017-053377] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/29/2017] [Accepted: 02/08/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective method for reducing HIV incidence among at-risk populations. However, concerns exist over the potential for an increase in STIs following PrEP initiation. The objective of this study is to compare the STI incidence before and after PrEP initiation within subjects among a cohort of men who have sex with men in Los Angeles, California. METHODS The present study used data from patients who initiated PrEP services at the Los Angeles LGBT Center between October 2015 and October 2016 (n=275). A generalised linear mixed model was used with a case-crossover design to determine if there was a significant difference in STIs within subjects 365 days before (before-PrEP period) and 365 days after PrEP initiation (after-PrEP period). RESULTS In a generalised linear mixed model, there were no significant differences in urethral gonorrhoea (P=0.95), rectal gonorrhoea (P=0.33), pharyngeal gonorrhoea (P=0.65) or urethral chlamydia (P=0.71) between periods. There were modest increases in rectal chlamydia (rate ratio (RR) 1.83; 95% CI 1.13 to 2.98; P=0.01) and syphilis diagnoses (RR 2.97; 95% CI 1.23 to 7.18; P=0.02). CONCLUSIONS There were significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.
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Affiliation(s)
- Matthew R Beymer
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Michelle A DeVost
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California, USA
| | | | - Chelsea L Shover
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Raphael J Landovitz
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Center for Clinical AIDS Research and Education (CARE), Los Angeles, California, USA
| | - Corinne Beniasians
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Ali J Talan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Risa P Flynn
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Robyn Krysiak
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Kayla McLaughlin
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Robert K Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
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Bil JP, Hoornenborg E, Prins M, Hogewoning A, Dias Goncalves Lima F, de Vries HJC, Davidovich U. The Acceptability of Pre-Exposure Prophylaxis: Beliefs of Health-Care Professionals Working in Sexually Transmitted Infections Clinics and HIV Treatment Centers. Front Public Health 2018; 6:5. [PMID: 29479524 PMCID: PMC5811525 DOI: 10.3389/fpubh.2018.00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV infections, but is not yet implemented in the Netherlands. As the attitudes of health-care professionals toward PrEP can influence future PrEP implementation, we studied PrEP knowledge and beliefs and their association with PrEP acceptability among professionals in clinics for sexually transmitted infection (STI professionals) and HIV treatment centers (HIV specialists). In addition, we examined preferred regimens, attitudes toward providing PrEP to key populations and to reimbursement of PrEP costs. Methods An online questionnaire was distributed among 24 public health STI clinics and 27 HIV treatment centers nationwide in the Netherlands between January and August 2015. The acceptability of PrEP was measured on a 7-point Likert scale ranging from 1 = low to 7 = high acceptability. Univariable and multivariable linear regression analyses were used to explore associations between demographic characteristics, PrEP knowledge, beliefs about PrEP, and PrEP acceptability. Results In total, 209 people (143 STI professionals and 66 HIV specialists) completed the questionnaire. The mean acceptability of PrEP implementation was 4.28 (SD 1.68) among STI professionals and 4.42 (SD 1.67) among HIV specialists. The mean score on self-perceived knowledge related to PrEP efficacy was 3.90 (SD 1.57) among STI professionals and 5.68 (SD 1.08) among HIV specialists (p-value of <0.001). Beliefs associated with lower PrEP acceptability among both groups were the fear that PrEP use will lead to a decrease in condom use and an increase in STI, the high costs of PrEP and ethical issues regarding prescribing antiretroviral medication to healthy individuals. No preference for a daily or an event-driven regimen was detected. Most participants deemed the following groups to be eligible for PrEP: men who have sex with men (MSM) who regularly get post-exposure prophylaxis, MSM who never used condoms with casual partners and MSM with an HIV-positive partner with a detectable viral load. Over half of the participants indicated that PrEP users should partly (54.1%) or fully (35.4%) pay the costs of PrEP. Conclusion In 2015, PrEP acceptability was only moderate among Dutch STI professionals and HIV specialists, which is far from an optimal setting. Addressing barriers to PrEP acceptability in educational programs for various types of health-care professionals is needed to successfully implement PrEP in the Netherlands.
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Affiliation(s)
- Janneke P Bil
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Maria Prins
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Arjan Hogewoning
- Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Fernando Dias Goncalves Lima
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Henry J C de Vries
- Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Internal Medicine, Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
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32
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Kahle EM, Sullivan S, Stephenson R. Functional Knowledge of Pre-Exposure Prophylaxis for HIV Prevention Among Participants in a Web-Based Survey of Sexually Active Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study. JMIR Public Health Surveill 2018; 4:e13. [PMID: 29362213 PMCID: PMC5801519 DOI: 10.2196/publichealth.8089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/09/2017] [Accepted: 11/08/2017] [Indexed: 01/24/2023] Open
Abstract
Background Awareness of pre-exposure prophylaxis (PrEP) for HIV prevention is increasing, but little is known about the functional knowledge of PrEP and its impact on willingness to use PrEP. Objective The objective of this study was to assess the functional knowledge of PrEP among a sample of gay, bisexual, and other men who have sex with men (MSM) participating in a Web-based survey of sexually active MSM. Methods Men at least 18 years old, residing in the United States, and reporting sex with a man in the previous 6 months were recruited through social networking websites. PrEP functional knowledge included the following 4 questions (1) efficacy of consistent PrEP use, (2) inconsistent PrEP use and effectiveness, (3) PrEP and condom use, and (4) effectiveness at reducing sexually transmitted infections (STIs). Ordinal logistic regression was used to identify respondent characteristics associated with PrEP functional knowledge. In a subsample of participants responding to HIV prevention questions, we compared willingness to use PrEP by response to PrEP functional knowledge using logistic regression analysis adjusted for age, race and ethnicity, and education level. Results Among 573 respondents, PrEP knowledge was high regarding adherence (488/573, 85.2%), condom use (532/573, 92.8%), and STIs (480/573, 83.8%), but only 252/573 (44.0%) identified the correct efficacy. Lower functional PrEP knowledge was associated with minority race/ethnicity (P=.005), lower education (P=.01), and not having an HIV test in the past year (P=.02). Higher PrEP knowledge was associated with willingness to use PrEP (P=.009). Younger age was not associated with higher PrEP functional knowledge or willingness to use PrEP. Conclusions PrEP knowledge was generally high in our study, including condom use and consistent use but may be lacking in higher risk MSM. The majority of respondents did not correctly identify PrEP efficacy with consistent use, which could impact motivation to seek out PrEP for HIV prevention. Targeted messaging to increase PrEP knowledge may increase PrEP use.
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Affiliation(s)
- Erin M Kahle
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
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Merriel SWD, Flannagan C, Kesten JM, Shapiro GK, Nadarzynski T, Prue G. Knowledge and Attitudes of General Practitioners and Sexual Health Care Professionals Regarding Human Papillomavirus Vaccination for Young Men Who Have Sex with Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E151. [PMID: 29346307 PMCID: PMC5800250 DOI: 10.3390/ijerph15010151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/22/2022]
Abstract
Men who have sex with men (MSM) may be at higher risk for human papillomavirus (HPV)-associated cancers. Healthcare professionals' recommendations can affect HPV vaccination uptake. Since 2016, MSM up to 45 years have been offered HPV vaccination at genitourinary medicine (GUM) clinics in a pilot programme, and primary care was recommended as a setting for opportunistic vaccination. Vaccination prior to potential exposure to the virus (i.e., sexual debut) is likely to be most efficacious, therefore a focus on young MSM (YMSM) is important. This study aimed to explore and compare the knowledge and attitudes of UK General Practitioners (GPs) and sexual healthcare professionals (SHCPs) regarding HPV vaccination for YMSM (age 16-24). A cross-sectional study using an online questionnaire examined 38 GPs and 49 SHCPs, including 59 (67.82%) females with a mean age of 40.71 years. Twenty-two participants (20 SHCPs, p < 0.001) had vaccinated a YMSM patient against HPV. GPs lack of time (25/38, 65.79%) and SHCP staff availability (27/49, 55.10%) were the main reported factors preventing YMSM HPV vaccination. GPs were less likely than SHCPs to believe there was sufficient evidence for vaccinating YMSM (OR = 0.02, 95% CI = 0.01, 0.47); less likely to have skills to identify YMSM who may benefit from vaccination (OR = 0.03, 95% CI = 0.01, 0.15); and less confident recommending YMSM vaccination (OR = 0.01, 95% CI = 0.00, 0.01). GPs appear to have different knowledge, attitudes, and skills regarding YMSM HPV vaccination when compared to SHCPs.
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Affiliation(s)
- Samuel W D Merriel
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Londonderry BT52 1SA, UK.
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK.
| | - Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton SO17 1BJ, UK.
| | - Gillian Prue
- School of Nursing and Midwifery, Queens University, Belfast BT7 1NN, UK.
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Abstract
Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.
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Affiliation(s)
- Monica Desai
- HIV and STI Department, Public Health England, London NW9 5EQ, UK
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, University College London, London WC1E 6BT, UK
| | - Robert Grant
- University of California School of Medicine; Gladstone Institutes; San Francisco AIDS Foundation, San Francisco, CA 94115, USA
| | - Sheena McCormack
- MRC Clinical Trials Unit, University College London, London
- Chelsea and Westminster Hospital, London SW10 9BH
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Krakower DS, Ware NC, Maloney KM, Wilson IB, Wong JB, Mayer KH. Differing Experiences with Pre-Exposure Prophylaxis in Boston Among Lesbian, Gay, Bisexual, and Transgender Specialists and Generalists in Primary Care: Implications for Scale-Up. AIDS Patient Care STDS 2017; 31:297-304. [PMID: 28574774 DOI: 10.1089/apc.2017.0031] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The Centers for Disease Control and Prevention estimates that one in four sexually active men who have sex with men (MSM) could decrease their HIV risk by using HIV pre-exposure prophylaxis (PrEP). Because many MSM access healthcare from primary care providers (PCPs), these clinicians could play an important role in providing access to PrEP. Semistructured qualitative interviews were conducted with 31 PCPs in Boston, MA, to explore how they approach decisions about prescribing PrEP to MSM and their experiences with PrEP provision. Purposive sampling included 12 PCPs from an urban community health center specializing in the care of lesbian, gay, bisexual, and transgender persons ("LGBT specialists") and 19 PCPs from a general academic medical center ("generalists"). Analyses utilized an inductive approach to identify emergent themes. Both groups of PCPs approached prescribing decisions about PrEP as a process of informed decision-making with patients. Providers would defer to patients' preferences if they were unsure about the appropriateness of PrEP. LGBT specialists and generalists were at vastly different stages of adopting PrEP into practice. For LGBT specialists, PrEP was a disruptive innovation that rapidly became normative in practice. Generalists had limited experience with PrEP; however, they desired succinct decision-support tools to help them achieve proficiency, because they considered preventive medicine to be central to their professional role. As generalists vastly outnumber LGBT specialists in the United States, interventions to support PrEP provision by generalists could accelerate the scale-up of PrEP for MSM nationally, which could in turn decrease HIV incidence for this priority population.
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Affiliation(s)
- Douglas S. Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Norma C. Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kevin M. Maloney
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ira B. Wilson
- Division of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Kenneth H. Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
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Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists. AIDS Behav 2017; 21:1256-1267. [PMID: 27885552 DOI: 10.1007/s10461-016-1625-1] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) was FDA approved in 2012, but uptake remains low. To characterize what would facilitate health care providers' increased PrEP prescribing, we conducted a 10-city, online survey of 525 primary care providers (PCPs) and HIV providers (HIVPs) to assess awareness, knowledge, and experience with prescribing PrEP; and, comfort with and barriers to PrEP-related activities. Fewer PCPs than HIVPs had heard of PrEP (76 vs 98%), felt familiar with prescribing PrEP (28 vs. 76%), or had prescribed it (17 vs. 64%). PCPs were less comfortable than HIVPs with PrEP-related activities such as discussing sexual activities (75 vs. 94%), testing for acute HIV (83 vs. 98%), or delivering a new HIV diagnosis (80 vs. 95%). PCPs most frequently identified limited knowledge about PrEP and concerns about insurance coverage as prescribing barriers. PCPs and HIVPs differ in needs that will facilitate their PrEP prescribing. Efforts to increase PrEP uptake will require interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP.
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Koechlin FM, Fonner VA, Dalglish SL, O'Reilly KR, Baggaley R, Grant RM, Rodolph M, Hodges-Mameletzis I, Kennedy CE. Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature. AIDS Behav 2017; 21:1325-1335. [PMID: 27900502 PMCID: PMC5378753 DOI: 10.1007/s10461-016-1627-z] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative people to prevent HIV infection. WHO released new guidelines in 2015 recommending PrEP for all populations at substantial risk of HIV infection. To prepare these guidelines, we conducted a systematic review of values and preferences among populations that might benefit from PrEP, women, heterosexual men, young women and adolescent girls, female sex workers, serodiscordant couples, transgender people and people who inject drugs, and among healthcare providers who may prescribe PrEP. A comprehensive search strategy reviewed three electronic databases of articles and HIV-related conference abstracts (January 1990-April 2015). Data abstraction used standardised forms to categorise by population groups and relevant themes. Of 3068 citations screened, 76 peer-reviewed articles and 28 conference abstracts were included. Geographic coverage was global. Most studies (N = 78) evaluated hypothetical use of PrEP, while 26 studies included individuals who actually took PrEP or placebo. Awareness of PrEP was low, but once participants were presented with information about PrEP, the majority said they would consider using it. Concerns about safety, side effects, cost and effectiveness were the most frequently cited barriers to use. There was little indication of risk compensation. Healthcare providers would consider prescribing PrEP, but need more information before doing so. Findings from a rapidly expanding evidence base suggest that the majority of populations most likely to benefit from PrEP feel positively towards it. These same populations would benefit from overcoming current implementation challenges with the shortest possible delay.
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Affiliation(s)
- Florence M Koechlin
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland.
| | - Virginia A Fonner
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Sarah L Dalglish
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Kevin R O'Reilly
- Department of Psychiatry, Center for Global and Community Health, Medical University of South Carolina, 176 Croghan Spur Rd Suite 104, Charleston, SC, 29407, USA
| | - Rachel Baggaley
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Robert M Grant
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Michelle Rodolph
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Ioannis Hodges-Mameletzis
- Key Populations & Innovative Prevention (KPP), Department of HIV and Global Hepatitis Programme, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Caitlin E Kennedy
- International Health and the Program is Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Silapaswan A, Krakower D, Mayer KH. Pre-Exposure Prophylaxis: A Narrative Review of Provider Behavior and Interventions to Increase PrEP Implementation in Primary Care. J Gen Intern Med 2017; 32:192-198. [PMID: 27761767 PMCID: PMC5264683 DOI: 10.1007/s11606-016-3899-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 01/04/2023]
Abstract
Since FDA approval of HIV pre-exposure prophylaxis (PrEP) for HIV prevention, attention has been focused on PrEP implementation. The CDC estimates that 1.2 million U.S. adults might benefit from PrEP, but only a minority are using PrEP, so there is a significant unmet need to increase access for those at risk for HIV. Given the large numbers of individuals who have indications for PrEP, there are not enough practicing specialists to meet the growing need for providers trained in providing PrEP. Moreover, since PrEP is a preventive intervention for otherwise healthy individuals, primary care providers (PCPs) should be primary prescribers of PrEP. There are important clinical considerations that providers should take into account when planning to prescribe PrEP, which are highlighted in the clinical case discussed. A growing body of research also suggests that some providers may be cautious about prescribing PrEP because of concerns regarding its "real-world" effectiveness, anticipated unintended consequences associated with its use, and ambiguity as to who should prescribe it. This review summarizes findings from studies that have assessed prescriber behavior regarding provision of PrEP, and offers recommendations on how to optimize PrEP implementation in primary care settings. Development and dissemination of educational interventions for PCPs and potential PrEP users are needed, including improved methods to assist clinicians in identifying appropriate PrEP candidates, and programs to promote medication adherence and access to social and behavioral health services. PCPs are well-positioned to prescribe PrEP and coordinate health-related services to improve the sexual health of their patients, but tailored educational programs are needed.
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Affiliation(s)
- Andrew Silapaswan
- Fenway Health, The Fenway Institute, 1340 Boylston St., Boston, MA, 02215, USA.,New York Medical College, Valhalla, NY, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Douglas Krakower
- Fenway Health, The Fenway Institute, 1340 Boylston St., Boston, MA, 02215, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kenneth H Mayer
- Fenway Health, The Fenway Institute, 1340 Boylston St., Boston, MA, 02215, USA. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians. J Gen Intern Med 2017; 32:62-70. [PMID: 27778215 PMCID: PMC5215171 DOI: 10.1007/s11606-016-3903-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/29/2016] [Accepted: 10/05/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Among health care providers, prescription of HIV pre-exposure prophylaxis (PrEP) has been low. Little is known specifically about primary care physicians (PCPs) with regard to PrEP awareness and adoption (i.e., prescription or referral), and factors associated with adoption. OBJECTIVE To assess PrEP awareness, PrEP adoption, and factors associated with adoption among PCPs. DESIGN Cross-sectional online survey conducted in April and May 2015. RESPONDENTS Members of a national professional organization for academic primary care physicians (n = 266). MAIN MEASURES PrEP awareness, PrEP adoption (ever prescribed or referred a patient for PrEP [yes/no]), provider and practice characteristics, and self-rated knowledge, attitudes, and beliefs associated with adoption. KEY RESULTS The survey response rate was 8.6 % (266/2093). Ninety-three percent of respondents reported prior awareness of PrEP. Of these, 34.9 % reported PrEP adoption. In multivariable analysis of provider and practice characteristics, compared with non-adopters, adopters were more likely to provide care to more than 50 HIV-positive patients (vs. 0, aOR = 6.82, 95 % CI 2.06-22.52). Compared with non-adopters, adopters were also more likely to report excellent, very good, or good self-rated PrEP knowledge (15.1 %, 33.7 %, 30.2 % vs. 2.5 %, 18.1 %, 23.8 %, respectively; p < 0.001) and to perceive PrEP as extremely safe (35.1 % vs. 10.7 %; p = 0.002). Compared with non-adopters, adopters were less likely to perceive PrEP as being moderately likely to increase risk behaviors ("risk compensation") (12.8 % vs. 28.8 %, p = 0.02). CONCLUSIONS While most respondents were aware of PrEP, only one-third of PrEP-aware PCPs reported adoption. Adopters were more likely to have experience providing HIV care and to perceive PrEP as extremely safe, and were less likely to perceive PrEP use as leading to risk compensation. To enhance PCP adoption of PrEP, educational efforts targeting PCPs without HIV care experience should be considered, as well as training those with HIV care experience to be PrEP "clinical champions". Concerns about safety and risk compensation must also be addressed.
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40
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Zablotska I, Grulich AE, Phanuphak N, Anand T, Janyam S, Poonkasetwattana M, Baggaley R, van Griensven F, Lo YR. PrEP implementation in the Asia-Pacific region: opportunities, implementation and barriers. J Int AIDS Soc 2016; 19:21119. [PMID: 27760688 PMCID: PMC5071746 DOI: 10.7448/ias.19.7.21119] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION HIV epidemics in the Asia-Pacific region are concentrated among men who have sex with men (MSM) and other key populations. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention and could be a potential game changer in the region. We discuss the progress towards PrEP implementation in the Asia-Pacific region, including opportunities and barriers. DISCUSSION Awareness about PrEP in the Asia-Pacific is still low and so are its levels of use. A high proportion of MSM who are aware of PrEP are willing to use it. Key PrEP implementation barriers include poor knowledge about PrEP, limited access to PrEP, weak or non-existent HIV prevention programmes for MSM and other key populations, high cost of PrEP, stigma and discrimination against key populations and restrictive laws in some countries. Only several clinical trials, demonstration projects and a few larger-scale implementation studies have been implemented so far in Thailand and Australia. However, novel approaches to PrEP implementation have emerged: researcher-, facility- and community-led models of care, with PrEP services for fee and for free. The WHO consolidated guidelines on HIV testing, treatment and prevention call for an expanded access to PrEP worldwide and have provided guidance on PrEP implementation in the region. Some countries like Australia have released national PrEP guidelines. There are growing community leadership and consultation processes to initiate PrEP implementation in Asia and the Pacific. CONCLUSIONS Countries of the Asia-Pacific region will benefit from adding PrEP to their HIV prevention packages, but for many this is a critical step that requires resourcing. Having an impact on the HIV epidemic requires investment. The next years should see the region transitioning from limited PrEP implementation projects to growing access to PrEP and expansion of HIV prevention programmes.
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Affiliation(s)
| | | | | | - Tarandeep Anand
- The Thai Red Cross AIDS and Research Centre, Bangkok, Thailand
| | - Surang Janyam
- Service Workers In Group Foundation, Bangkok, Thailand
| | | | - Rachel Baggaley
- HIV Department, World Health Organization, Geneva, Switzerland
| | - Frits van Griensven
- HIV Netherlands, Australia, Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Ying-Ru Lo
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
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Abstract
Purpose of review The review describes the European epidemic and the challenges in moving from clinical trials of preexposure prophylaxis (PrEP) to routine practice. Recent findings Two European trials conducted in gay and other MSM and transgender women reported a high and consistent reduction in HIV incidence using oral PrEP with tenofovir/emtricitabine (TDF/FTC). The incidence of HIV infection in the control group was much higher than anticipated, based on routine surveillance data in MSM, in spite of the highest standard of HIV prevention available. Summary Recent results have highlighted the urgent need to make PrEP available to key populations in Europe as an additional prevention tool. Gilead has not yet submitted an application to use TDF/FTC as PrEP in Europe. Although regulatory approval would accelerate implementation, countries are already dispensing TDF/FTC as postexposure prophylaxis without this. Services for prevention are diverse across countries ranging from free, walk-in services for the diagnosis and treatment of HIV and other sexually transmitted infections, to insurance-dependent reimbursement of private clinical services. Momentum is gathering in Europe with PrEP demonstration projects in MSM and a growing demand from community organizations. Each Member State urgently needs to identify their key populations and determine the service best placed to provide this new prevention strategy within a comprehensive prevention package.
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Abstract
PURPOSE OF REVIEW To review the most recent studies assessing the preparedness of healthcare practitioners to provide anti-HIV preexposure prophylaxis (PrEP) and suggest areas for future implementation research. RECENT FINDINGS As PrEP is a biobehavioral intervention, healthcare providers are likely to play a critical role in implementing PrEP in care settings. Studies suggest that many specialized providers are aware of PrEP and support its provision as a public health intervention, though knowledge and acceptance are less among generalists. Therefore, utilization of PrEP by clinicians has been limited to a few early adopters. Concerns about the efficacy and long-term safety of PrEP, and perceived barriers to prescribing PrEP, could limit prescribing behaviors and intentions. Resistance to performing routine HIV risk assessments by clinicians is an additional barrier to implementing PrEP, although innovative tools to help clinicians routinely perform risk assessments, are being developed. SUMMARY Interventions are needed to engage a broader array of healthcare providers in PrEP provision. Utilizing a framework based on diffusion of innovation theory, this review proposes strategies that can be implemented and evaluated to increase PrEP prescribing by healthcare providers. If resources are invested in training clinicians to provide PrEP, then these stakeholders could enhance the use of PrEP as part of a prevention package by primary providers.
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Mullins TLK, Zimet G, Lally M, Kahn JA. Adolescent Human Immunodeficiency Virus Care Providers' Attitudes Toward the Use of Oral Pre-Exposure Prophylaxis in Youth. AIDS Patient Care STDS 2016; 30:339-48. [PMID: 27410497 DOI: 10.1089/apc.2016.0048] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Oral pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is currently indicated for use in adults in the United States and may soon be indicated for minor adolescents. However, implementation of PrEP use among minors may present unique barriers. We conducted 15 individual, semi-structured interviews among US clinicians caring for HIV-infected and at-risk youth. The theory-driven interview guide assessed demographics, perceived role of oral PrEP in HIV prevention among adolescents, perceived barriers to and facilitating factors for use of PrEP in adolescents, and clinician-reported likelihood of prescribing PrEP. Transcripts were analyzed using framework analysis. Overall, clinicians viewed PrEP as a time-limited intervention that is one part of a comprehensive approach to HIV prevention among adolescents. Perceived barriers to prescribing to minors included concerns about: confidentiality, legality of minors consenting to PrEP without parental involvement, ability of minors to understand the risks/benefits of PrEP, the possible impact of PrEP on bone accrual, off-label use of PrEP medication in minors, and the high costs associated with PrEP use. Clinician-reported facilitating factors for prescribing PrEP to youth included educating communities and other clinicians about PrEP, ensuring adequate financial resources and infrastructure for delivering PrEP, developing formal guidance on effective behavioral interventions that should be delivered with PrEP, and gaining personal experience with prescribing PrEP. Clinicians indicated greater comfort with prescribing PrEP to adults versus minors. For PrEP to become more widely available to youth at risk for HIV infection, barriers that are unique to PrEP use in minors must be addressed.
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Affiliation(s)
- Tanya L. Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gregory Zimet
- Division of Adolescent Medicine, Indiana University, Indianapolis, Indiana
| | - Michelle Lally
- Division of Infectious Diseases, Department of Medicine, Lifespan Hospital System/Alpert Medical School of Brown University, Providence, Rhode Island
- Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Jessica A. Kahn
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Dolling DI, Desai M, McOwan A, Gilson R, Clarke A, Fisher M, Schembri G, Sullivan AK, Mackie N, Reeves I, Portman M, Saunders J, Fox J, Bayley J, Brady M, Bowman C, Lacey CJ, Taylor S, White D, Antonucci S, Gafos M, McCormack S, Gill ON, Dunn DT, Nardone A. An analysis of baseline data from the PROUD study: an open-label randomised trial of pre-exposure prophylaxis. Trials 2016; 17:163. [PMID: 27013513 PMCID: PMC4806447 DOI: 10.1186/s13063-016-1286-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 03/14/2016] [Indexed: 01/20/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) has proven biological efficacy to reduce the sexual acquisition of the human immunodeficiency virus (HIV). The PROUD study found that PrEP conferred higher protection than in placebo-controlled trials, reducing HIV incidence by 86 % in a population with seven-fold higher HIV incidence than expected. We present the baseline characteristics of the PROUD study population and place the findings in the context of national sexual health clinic data. Methods The PROUD study was designed to explore the real-world effectiveness of PrEP (tenofovir-emtricitabine) by randomising HIV-negative gay and other men who have sex with men (GMSM) to receive open-label PrEP immediately or after a deferral period of 12 months. At enrolment, participants self-completed two baseline questionnaires collecting information on demographics, sexual behaviour and lifestyle in the last 30 and 90 days. These data were compared to data from HIV-negative GMSM attending sexual health clinics in 2013, collated by Public Health England using the genitourinary medicine clinic activity database (GUMCAD). Results The median age of participants was 35 (IQR: 29–43). Typically participants were white (81 %), educated at a university level (61 %) and in full-time employment (72 %). Of all participants, 217 (40 %) were born outside the UK. A sexually transmitted infection (STI) was reported to have been diagnosed in the previous 12 months in 330/515 (64 %) and 473/544 (87 %) participants reported ever having being diagnosed with an STI. At enrolment, 47/280 (17 %) participants were diagnosed with an STI. Participants reported a median (IQR) of 10 (5–20) partners in the last 90 days, a median (IQR) of 2 (1–5) were condomless sex acts where the participant was receptive and 2 (1–6) were condomless where the participant was insertive. Post-exposure prophylaxis had been prescribed to 184 (34 %) participants in the past 12 months. The number of STI diagnoses was high compared to those reported in GUMCAD attendees. Conclusions The PROUD study population are at substantially higher risk of acquiring HIV infection sexually than the overall population of GMSM attending sexual health clinics in England. These findings contribute to explaining the extraordinary HIV incidence rate during follow-up and demonstrate that, despite broad eligibility criteria, the population interested in PrEP was highly selective. Trial registration Current Controlled TrialsISRCTN94465371. Date of registration: 28 February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1286-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David I Dolling
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Monica Desai
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.,HIV/STI Department, Public Health England, London, UK
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Gilson
- The Mortimer Market Centre, Central and Northwest London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nichol Centre, Royal Surrey Sussex County Hospital, Brighton, UK
| | - Martin Fisher
- Claude Nichol Centre, Royal Surrey Sussex County Hospital, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicola Mackie
- St Mary's Hospital, Imperial College NHS Foundation Trust, London, UK
| | - Iain Reeves
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Mags Portman
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - John Saunders
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jake Bayley
- King's College Hospital NHS Foundation Trust, London, UK
| | - Michael Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - Christine Bowman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - David White
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Simone Antonucci
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Mitzy Gafos
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Sheena McCormack
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.
| | - Owen N Gill
- HIV/STI Department, Public Health England, London, UK
| | - David T Dunn
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
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