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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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Vega-Ramirez H, Torres TS, Guillen-Diaz C, Pimenta C, Diaz-Sosa D, Konda KA, da Cunha ARC, Robles-Garcia R, Benedetti M, Hoagland B, Bezerra DRB, Caceres CF, Grinsztejn B, Veloso VG. Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey. BMC Health Serv Res 2022; 22:532. [PMID: 35459177 PMCID: PMC9027096 DOI: 10.1186/s12913-022-07900-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In order to end the HIV epidemic by 2030, combination HIV prevention including pre-exposure prophylaxis (PrEP) should be widely available, especially for the most vulnerable populations. In Latin America and the Caribbean (LAC), only 14 out of 46 countries have access to PrEP. In Brazil and Mexico, PrEP has been provided at no cost through the Public Health System since 2017 and 2021, respectively. Thus, HIV physicians' perspectives about PrEP and other prevention strategies may differ. This study aimed to compare awareness, knowledge, and attitudes related to PrEP and other prevention strategies among HIV physicians from Brazil and Mexico. METHODS Cross-sectional, web-based survey targeting physicians who prescribe antiretrovirals from both countries. Participants answered questions on socio-demographic, medical experience, awareness, knowledge, and attitudes towards PrEP and other HIV prevention strategies. We stratified all variables per country and compared frequencies using Chi-square, Fisher exact, and Wilcoxon-Mann-Whitney tests, as appropriate. RESULTS From January-October 2020, 481 HIV physicians were included: 339(70.5%) from Brazil, 276(57.4%) male, and median age was 43 years (IQR = 36-53). Awareness of PrEP did not differ between Brazil and Mexico (84.6%), while awareness of other prevention strategies, including post-exposure prophylaxis and new PrEP technologies, was higher in Brazil. More Brazilians perceived U=U as completely accurate compared to Mexicans (74.0% vs. 62.0%, P < .001). Willingness to prescribe PrEP was 74.2%, higher among Brazilians (78.2%, P = .01). Overall, participants had concerns about consistent access to PrEP medication and the risk of antiretroviral resistance in case of acute HIV infection or seroconversion. The main barriers reported were assumptions that users could have low PrEP knowledge (62.0%) or limited capacity for adherence (59.0%). Compared to Brazilians, Mexicans reported more concerns and barriers to PrEP prescription (all; P ≤ .05), except for consistent access to PrEP medication and the lack of professionals to prescribe PrEP (both; P ≤ .01). CONCLUSIONS Although awareness of PrEP was similar in Brazil and Mexico, differences in knowledge and attitudes may reflect the availability and stage of PrEP implementation in these countries. Strengthening and increasing information on PrEP technologies and other HIV prevention strategies among HIV physicians could improve their comfort to prescribe these strategies and facilitate their scale-up in LAC.
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Affiliation(s)
- Hamid Vega-Ramirez
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370 Mexico City, Mexico
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ Brazil
| | - Centli Guillen-Diaz
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370 Mexico City, Mexico
| | | | - Dulce Diaz-Sosa
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370 Mexico City, Mexico
| | - Kelika A. Konda
- Center for Interdisciplinary Research in Sexuality, Health, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Rebeca Robles-Garcia
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370 Mexico City, Mexico
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ Brazil
| | - Daniel R. B. Bezerra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ Brazil
| | - Carlos F. Caceres
- Center for Interdisciplinary Research in Sexuality, Health, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ Brazil
| | - for the ImPrEP Study Group
- Center for Research in Global Mental Health, National Institute of Psychiatry Ramon de la Fuente Muñiz, Calzada México-Xochimilco 101, Col. San Lorenzo Huipulco, Alc. Tlalpan, 14370 Mexico City, Mexico
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ Brazil
- Ministry of Health, Brasilia, DF Brazil
- Center for Interdisciplinary Research in Sexuality, Health, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
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Falconi‐McCahill A, Lee ASD, Knights JE. Evaluation of a pre‐exposure prophylaxis (PrEP) program for HIV prevention in a federally qualified health center (FQHC). Worldviews Evid Based Nurs 2022; 19:219-226. [DOI: 10.1111/wvn.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/19/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Amy S. D. Lee
- Capstone College of Nursing The University of Alabama Tuscaloosa Alabama USA
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Haffejee F, Fasanmi-Kana O, Ally F, Thandar Y, Basdav J. Four years later: Do South Africans know what pre-exposure prophylaxis for HIV is? AIDS Care 2022; 35:466-473. [PMID: 35109735 DOI: 10.1080/09540121.2022.2032573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV incidence remains high among South Africans, with low uptake of preventative measures such as condom use. Pre-exposure prophylaxis (PrEP), which protects HIV-negative individuals from infection, was first introduced in SA in 2016. This study determined the knowledge of PrEP among university students (n = 282) and primary health care clinic users (n = 358) in KwaZulu-Natal, South Africa. Data were collected using a cross-sectional survey. The study population was at high-risk of HIV infection, with early age of sexual debut, multiple concurrent sexual partners and inconsistent condom usage. Only 12.3% (n = 79) stated that they had a full understanding of PrEP, which was higher among university students (9.8%; n = 63) than clinic users (2.5%; n = 16; p < 0.001). Specific PrEP knowledge was, however, low. Health Science students did not have a better knowledge than students from other faculties. Neither did users of clinics offering PrEP have a better knowledge than users of clinics not offering PrEP. Moreover, few participants (15%; n = 96) were aware of the availability of PrEP at their local clinic. Interventions to address the low level of PrEP knowledge within the population are required, to reduce the high HIV incidence.
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Affiliation(s)
- Firoza Haffejee
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Olayinka Fasanmi-Kana
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Fazila Ally
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Yasmeen Thandar
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Jyotika Basdav
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
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Lau JYC, Wong NS, Lee KCK, Kwan TH, Lui GCY, Chan DPC, Lee SS. What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM. Int J STD AIDS 2022; 33:322-329. [PMID: 34978228 DOI: 10.1177/09564624211060824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective means of HIV prevention for men who have sex with men (MSM), a key population whose engagement is crucial for achieving effective public health outcomes. An optimal service model would be important in planning the implementation of PrEP in places where such service has not been established. METHODS A qualitative study was conducted to delineate the attributes of an optimal PrEP service model for MSM in Hong Kong, a city where no formal PrEP programs existed. Twenty purposively sampled MSM who were enrollees of two pilot PrEP projects participated in the semi-structured interviews promoting story-telling. The coded data were thematically analyzed following Grounded Theory approach, focusing on uncovering a typology of the essential attributes of an optimal PrEP service model, and the reasons for such preferences. RESULTS Participating MSM were all ethnic Chinese and aged 26 to 52 years. All had received PrEP from pilot projects in conjunction with periodic screening of sexually transmitted infections (STI), HIV antibody, and plasma creatinine. Four major themes emerged as regards the attributes of a preferred PrEP service: (i) comprehensiveness of HIV/STI and safety monitoring; (ii) convenient unitary service; (iii) stigma-free PrEP access and protecting confidentiality; and (iv) affordable price. Whereas regular provision of PrEP was acceptable to MSM, unaffordability and related stigma were the anticipated challenges for potential service providers. CONCLUSIONS The qualitative assessment of MSM's preference for PrEP service delivery has yielded important information on the many facets of a desirable service model.
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Affiliation(s)
- Janice Y C Lau
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Ngai-Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Krystal C K Lee
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China.,Department of Psychiatry, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Tsz-Ho Kwan
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Grace C Y Lui
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China.,Department of Medicine and Therapeutics, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Denise P C Chan
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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Wisutep P, Sirijatuphat R, Navanukroh O, Phatharodom P, Werarak P, Rattanasuwan W. Attitudes towards, knowledge about, and confidence to prescribe antiretroviral pre-exposure prophylaxis among healthcare providers in Thailand. Medicine (Baltimore) 2021; 100:e28120. [PMID: 34889271 PMCID: PMC8663816 DOI: 10.1097/md.0000000000028120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
HIV pre-exposure prophylaxis (HIV-PrEP) is an effective method for preventing HIV transmission, and it is recommended in several international guidelines. Perceptions and knowledge about HIV-PrEP prescription among healthcare providers have not been investigated in Thailand where HIV-PrEP is a novel healthcare topic. The objective of study was to determine healthcare providers' attitudes towards, knowledge about, and confidence to prescribe HIV-PrEP in Thailand.A questionnaire was administered to Thai healthcare providers during May 1, 2017 to September 5, 2018.Of the 500 questionnaires that were distributed, 460 were returned (92%). Respondents included 336 physicians (48 infectious disease [ID] physicians, 288 non-ID physicians) and 124 non-physicians (70 nurses, 35 pharmacists, and 19 others). Eighty one percent of respondents had a positive attitude towards HIV-PrEP. Multivariate analysis revealed being a non-ID physician, having prior knowledge about HIV-PrEP, believing that HIV-PrEP can reduce the number of new patients, and believing that HIV-PrEP is not associated with a higher incidence of other sexually transmitted infections were all factors significantly associated with having a positive attitude towards HIV-PrEP. The issue of most concern to respondents who had a negative attitude toward HIV-PrEP was poor patient adherence to antiviral medications. Only 57% of respondents had confidence to prescribe HIV-PrEP. Factors associated with confidence to prescribe HIV-PrEP included being an ID physician, believing that HIV-PrEP can reduce the number of new patients, believing in the safety of antiviral medications, and believing that HIV-PrEP is not associated with increased development of HIV drug resistance. The results of HIV-PrEP knowledge testing (8 questions) were categorized into good score (≥7/8) and fair score (≤6/8). Fifty five percent of participants had a good score result. Using multivariate analysis, the factors associated with a good score result were ID physician, having HIV-PrEP prescription experience, and believing that HIV-PrEP can reduce the number of new patients.Most Thai healthcare providers (81%) reported having a positive attitude towards HIV-PrEP. Successful HIV-PrEP implementation in Thailand will require steps to mitigate the described barriers, and training for healthcare providers, which will strengthen knowledge and improve both experience with and confidence to prescribe HIV-PrEP.
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Affiliation(s)
- Pruettichai Wisutep
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- School of Medicine, Institute of Medicine, Suranaree University of Technologgy, Nakornratchasima, Thailand
| | - Rujipas Sirijatuphat
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Oranich Navanukroh
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phatharajit Phatharodom
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerawong Werarak
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Winai Rattanasuwan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Public Health Detailing to Promote HIV Pre- and Postexposure Prophylaxis Among Women's Healthcare Providers in New York City. Am J Prev Med 2021; 61:S98-S107. [PMID: 34686296 DOI: 10.1016/j.amepre.2021.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Equitable access to HIV pre- and postexposure prophylaxis for women is essential to ending the HIV epidemic. Providers' lack of knowledge and comfort in discussing and prescribing pre-exposure prophylaxis to women persist as barriers. METHODS From May to November 2019, the New York City Health Department conducted its first public health detailing campaigns among women's healthcare providers to promote pre- and postexposure prophylaxis and the associated best practices. Over 2 campaigns (10 weeks each), trained Health Department representatives visited providers for 1-on-1 visits at select practices to promote key messages. Representatives distributed an Action Kit that addressed knowledge gaps and practice needs on providing pre-exposure prophylaxis and postexposure prophylaxis to cisgender and transgender women. Providers completed an assessment at the beginning of initial and follow-up visits, used to compare responses across visits. Statistically significant changes were evaluated by generalized linear models of bivariate outcomes, adjusted for nonindependence of providers at the same practice. RESULTS Representatives visited 1,348 providers specializing in primary care (47%), women's health (30%), adolescent health (7%), infectious disease (4%), and other (12%) at 860 sites; 1,097 providers received initial and follow-up visits. Provider report of ever prescribing pre-exposure prophylaxis increased by 12% (n=119 providers); increases were reported in measures of taking sexual history, asking about partners' HIV status, providing postexposure prophylaxis, recognizing pre-exposure prophylaxis's effectiveness, and discussing and referring for pre-exposure prophylaxis. CONCLUSIONS After public health detailing, women's healthcare providers report increased adoption of recommended practices that promote pre- and postexposure prophylaxis uptake and sexual wellness among women. Detailing may be adaptable to other regions and contexts to reach providers.
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Lanham M, Ridgeway K, Mireku M, Nhamo D, Pillay D, Murire M, Stankevitz K, Kyongo J, Mullick S. Health care providers' attitudes toward and experiences delivering oral PrEP to adolescent girls and young women in Kenya, South Africa, and Zimbabwe. BMC Health Serv Res 2021; 21:1112. [PMID: 34663320 PMCID: PMC8522219 DOI: 10.1186/s12913-021-06978-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background In Kenya, South Africa, and Zimbabwe, oral pre-exposure prophylaxis (PrEP) is recommended for adolescent girls and young women (AGYW) at high risk of HIV. Health providers play a critical role in the uptake and effective use of sexual and reproductive health services; however, few published studies have explored providers’ attitudes toward and experiences delivering PrEP to AGYW. Methods We conducted a cross-sectional qualitative study, interviewing 113 providers at 36 public, private, and nongovernmental health facilities in Kenya, South Africa, and Zimbabwe that were offering PrEP during the research period or were likely to offer PrEP in the future. Data were coded in NVivo 11, and an applied thematic analysis was conducted. Results Most providers preferred that adolescent girls wait until age 18 to have sex but acknowledged that many girls younger than 18 could benefit from oral PrEP. Their primary concern was whether adolescent girls would be able to take PrEP daily, especially if they do not tell their parents or partners they are using it. Providers reported that it was more challenging to deliver PrEP and other HIV services to girls younger than 18. Those with experience providing PrEP pointed to stigma and lack of PrEP awareness in communities as two primary barriers to PrEP uptake and use. Conclusions Providers were generally accepting of oral PrEP as an HIV prevention option for AGYW; however, many had negative attitudes about adolescent girls being sexually active and concerns about whether they could take PrEP daily. Results were used to update national PrEP training materials to address negative provider attitudes about PrEP use by AGYW. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06978-0.
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Affiliation(s)
- Michele Lanham
- FHI 360, 359 Blackwell Street, Suite 201, NC, 27707, Durham, USA.
| | | | - Maryline Mireku
- LVCT Health, P.O. Box 19835-00202 KNH, Argwings Kodhek Road, Nairobi, Kenya
| | - Definate Nhamo
- Pangaea Zimbabwe AIDS Trust, 27 Rowland Square, Milton Park, Harare, Zimbabwe
| | - Diantha Pillay
- Wits Reproductive Health and HIV Institute, 31 Princess of Wales Terrace, 2193, Parktown, Johannesburg, South Africa
| | - Mercy Murire
- Wits Reproductive Health and HIV Institute, 31 Princess of Wales Terrace, 2193, Parktown, Johannesburg, South Africa
| | - Kayla Stankevitz
- FHI 360, 359 Blackwell Street, Suite 201, NC, 27707, Durham, USA
| | - Jordan Kyongo
- LVCT Health, P.O. Box 19835-00202 KNH, Argwings Kodhek Road, Nairobi, Kenya
| | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute, 31 Princess of Wales Terrace, 2193, Parktown, Johannesburg, South Africa
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Ayele WM, Tegegne TB, Damtie Y, Chanie MG, Mekonen AM. Prevalence of Consistent Condom Use and Associated Factors among Serodiscordant Couples in Ethiopia, 2020: A Mixed-Method Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9923012. [PMID: 34631890 PMCID: PMC8497122 DOI: 10.1155/2021/9923012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/26/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Heterosexual transmission within serodiscordant relationships is the core source of new HIV infections. Although consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples, it has not been extensively studied in Ethiopia. Consequently, the current study looked at the proportion of serodiscordant couples in Ethiopia who used condoms consistently and the factors associated with that. METHODS A cross-sectional was conducted from October 2019 to June 2020. For the quantitative findings to be more robust and reliable, a qualitative design was incorporated. An interviewer-administered questionnaire was used to collect the data. Qualitative data were collected using gender-matched four focus group discussions. Multivariable logistic regression was conducted to identify factors associated with consistent condom use. The statistical significance of the variables was declared at a P value of less than 0.05. RESULTS This study confirmed that the proportion of consistent condom use was 58.4% [95% CI: 53.1-63.1%]. After controlling for all other variables, unmarried partners, adjusted odds ratio (AOR) = 0.44 [95% CI: 0.229-0.877] and students and employees, AOR = 0.33 [95% CI: 0.130-0.846] and AOR = 0.39 [95% CI: 0.165-0.939], respectively, were less likely consistently use condoms, whereas couples living together, AOR = 1.86 [95% CI: 1.197-2.195], receiving counseling about condom use, AOR = 1.90 [95% CI: 1.182-3.076], and having more knowledge about HIV, AOR = 1.61 [95% CI: 1.031-2.525] were more likely to use condoms consistently. CONCLUSION Despite its importance, the proportion of consistent condom use among serodiscordant couples was significantly low. To improve condom use consistently, planners, policymakers, and health care practitioners should consider the factors listed above when making decisions. There should be an increased focus on student and employee intervention as well.
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Affiliation(s)
- Wolde Melese Ayele
- Department of Epidemiology & Biostatistics, School of Public Health, Wollo University, Ethiopia
| | - Tesfaye Birhane Tegegne
- Department of Reproductive and Family Health, School of Public Health, Wollo University, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, Wollo University, Ethiopia
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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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Phillips A, Harmon JL, Bera J, Ogle M, Thompson J. Integrating Preexposure Prophylaxis (PrEP) Into a Network of Community Health Centers. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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12
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Bepouka BI, Situakibanza H, Kokusa Y, Nkodila A, Kizunga F, Kiazayawoko F. [Care providers' knowledge and willingness to prescribe pre-exposure prophylaxis (PrEP) in Kinshasa, Democratic Republic of Congo (DRC)]. Pan Afr Med J 2019; 34:166. [PMID: 32153706 PMCID: PMC7046106 DOI: 10.11604/pamj.2019.34.166.18025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction la réduction de l'incidence de nouvelles infections liées au VIH est un objectif de santé publique. L’objectif de l’étude était d’évaluer la connaissance et volonté de prescrire la PrEP à Kinshasa. Méthodes il s’agit d’une étude transversale à visée analytique auprès des prestataires de soins de 4 structures de prise en charge de VIH/SIDA de la ville de Kinshasa d’avril à octobre 2017. Les analyses univariées et multivariées par régression logistique ont été effectuées pour identifier les facteurs associés à la connaissance et la volonté de prescrire la PrEP. Résultats quatre-vingt-cinq prestataires ont répondu à l’enquête. Moins du quart des prestataires connaissaient la PrEP avant l’enquête et la moitié avait la volonté de la prescrire. La barrière à cet acte évoquée était la résistance (83%). Les facteurs associés à la connaissance de la PrEP étaient la spécialité d’infectiologie et l’expertise en VIH. Les facteurs associés à la volonté de prescrire la PrEP étaient l’âge supérieur à 40 ans, la spécialité d’infectiologie et l’expertise en VIH. Conclusion la connaissance de la PrEP à Kinshasa était faible et seule la moitié des prestataires était disposée à la prescrire. Etre médecin infectiologue et expert en VIH était associé à la connaissance et la volonté de prescrire. Les futurs programmes d'éducation devraient renforcer la connaissance sur la PrEP et aborder les préoccupations identifiées dont les barrières à la prescription.
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Affiliation(s)
- Benilde Izizag Bepouka
- Service des Maladies Infectieuses et Tropicales, Département de Médecine Interne, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo
| | - Hippolyte Situakibanza
- Service des Maladies Infectieuses et Tropicales, Département de Médecine Interne, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo
| | - Yamin Kokusa
- Service des Maladies Infectieuses et Tropicales, Département de Médecine Interne, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo
| | | | - Francine Kizunga
- Service des Maladies Infectieuses et Tropicales, Département de Médecine Interne, Cliniques Universitaires, Faculté de Médecine, Université de Kinshasa, République Démocratique du Congo
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Meyerson BE, Dinh PC, Agley JD, Hill BJ, Motley DN, Carter GA, Jayawardene W, Ryder PT. Predicting Pharmacist Dispensing Practices and Comfort Related to Pre-exposure Prophylaxis for HIV Prevention (PrEP). AIDS Behav 2019; 23:1925-1938. [PMID: 30607758 PMCID: PMC8274484 DOI: 10.1007/s10461-018-02383-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To identify factors associated with pharmacist dispensing practice and comfort counseling patients about pre-exposure prophylaxis for HIV prevention (PrEP). Cross-sectional 2016 census of Indiana managing pharmacists measured PrEP awareness, comfort dispensing and counseling patients. Modified Poisson models with robust error variance estimated relative risks and confidence intervals. 15.8% of 284 pharmacists had dispensed PrEP and 11.6% had consulted about it. Dispensing and comfort counseling were associated with confidence in knowledge about PrEP medication adherence and adverse effects of PrEP medication; awareness about PrEP before the survey, number of full time pharmacists in their pharmacy, and increases in new HIV cases from 2015 to 2016 in communities served. Comfort counseling about PrEP was associated with the belief that pharmacists can be an important resource for HIV and HCV treatment.
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Affiliation(s)
- B E Meyerson
- Indiana University School of Public Health-Bloomington, 1025 E. 7th street, Bloomington, IN, 47405, USA.
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA.
| | - P C Dinh
- Indiana University School of Public Health-Bloomington, 1025 E. 7th street, Bloomington, IN, 47405, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN, USA
| | - J D Agley
- Indiana University School of Public Health-Bloomington, 1025 E. 7th street, Bloomington, IN, 47405, USA
- Indiana Prevention Research Center, Indiana University, Bloomington, IN, USA
- Institute for Research on Addictive Behavior, Indiana University, Bloomington, USA
| | - B J Hill
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, IL, USA
- Planned Parenthood Great Plains, Overland Park, KS, USA
| | - D N Motley
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, IL, USA
| | - G A Carter
- Indiana University School of Nursing, Bloomington, IN, USA
| | - W Jayawardene
- Indiana University School of Public Health-Bloomington, 1025 E. 7th street, Bloomington, IN, 47405, USA
- Indiana Prevention Research Center, Indiana University, Bloomington, IN, USA
- Institute for Research on Addictive Behavior, Indiana University, Bloomington, USA
| | - P T Ryder
- Larkin University College of Pharmacy, Miami, FL, USA
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Golub SA, Myers JE. Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men. AIDS Patient Care STDS 2019; 33:253-261. [PMID: 31094576 DOI: 10.1089/apc.2018.0290] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012-2015) and diffusion (2016-2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three "next-wave" challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.
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Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
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15
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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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Bulled N. Public health's social contract: An obstacle in the advancement of effective HIV technologies. Glob Public Health 2019; 14:1264-1274. [PMID: 30810469 DOI: 10.1080/17441692.2019.1585468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Evidence from the past 40 years of HIV technology development and implementation indicates that the public health social contract - with its expectations of patient/citizen compliance - has hampered global disease control efforts. Despite the availability of a wide array of effective technologies, including antiretroviral drugs as treatment and prevention, voluntary medical male circumcision procedures, and newly developed intravaginal ring products, new infections among adults globally have not decreased significantly. In this paper, I describe a historical trend of limiting access to effective biomedical technologies to those deemed most deserving and compliant given concerns of misuse (non-adherence), product repurposing (not using the product for purposes originally intended), and the incitement of autonomy (increasing the risk of public exposure to diseases given personal protection from a specific disease). Examining the expectations of good citizenship (compliance, adherence, appropriate product use, and continued risk reduction) as it relates to human-technology interactions, reveals a continuing narrative of initially restricting access to newer technologies perceived fragile or costly based on an assessment of patient/citizen worth. In this, the conventional public health social contract continues to be an obstacle in the advancements of technologies to effectively reduce the global burden of HIV.
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Affiliation(s)
- Nicola Bulled
- a Interdisciplinary and Global Studies Division , Worcester Polytechnic Institute , Worcester , USA
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Kambutse I, Igiraneza G, Ogbuagu O. Perceptions of HIV transmission and pre-exposure prophylaxis among health care workers and community members in Rwanda. PLoS One 2018; 13:e0207650. [PMID: 30475841 PMCID: PMC6261021 DOI: 10.1371/journal.pone.0207650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/05/2018] [Indexed: 12/28/2022] Open
Abstract
There are too many new HIV infections globally with 1.8 million persons infected in 2016 alone. Pre-exposure prophylaxis (PrEP) holds potential to decrease new infections and is synergistic with efforts currently in place to achieve an end to the AIDS epidemic in Sub-Saharan African, but uptake is limited. Given its novelty, assessing the beliefs and attitudes of healthcare professionals and members of the community towards HIV transmission and PrEP will be helpful to inform implementation efforts. Study was a random survey of 201 community members and 51 healthcare providers, carried out at multiple community sites in Huye district, Southern Province, Rwanda and at Kigali University Teaching Hospital (KUTH). The study findings are that there are still misconceptions about HIV in the community with some respondents believing that HIV is due to punishment from God (5.4%), poverty (3.0%), smoking cigarettes (1.0%), drinking alcohol (2.0%), punishment from ancestors (1.0%) and witchcraft (1.5%), and that its transmission is by mosquito bites (10.9%), sharing food or drinks with a HIV infected person (6.5%) or as a result of carelessness (47.8%). More than 50% of respondents from both groups had insufficient knowledge regarding PrEP, but expressed some interest in PrEP (82.6% of the respondents from the community and 86.5% of the health workers). However, some healthcare workers felt that promotion of safe sex practices (74.5%), HIV testing and treating HIV infected patients (60.8%) would work better than PrEP to decrease new HIV infections. Barriers to PrEP implementation included perceived stigma, delayed access to prevention services at the health facilities while personal-level concerns included lack of family support, reluctance to take a medication daily and fear of being perceived as having HIV. This study showed that health care workers and community members are willing to utilize PrEP in Rwanda, but many challenges exist including limited knowledge about PrEP, stigma, provider and system level service delivery barriers at health facilities among others. More studies are needed to assess ways of addressing and /or eliminating these barriers.
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Affiliation(s)
- Immaculate Kambutse
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- * E-mail:
| | - Grace Igiraneza
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Onyema Ogbuagu
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- Yale AIDS Program, Section of Infectious Diseases, Department of Medicine, Yale University, New Haven, Connecticut, United States of America
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Ntela SDM, Goutte N, Morvillers JM, Crozet C, Ahouah M, Omanyondo-Ohambe MC, Ntoto-Kunzi B, Kandolo FT, Rothan-Tondeur M. Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance. Pan Afr Med J 2018; 31:159. [PMID: 31065318 PMCID: PMC6488246 DOI: 10.11604/pamj.2018.31.159.15132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/12/2018] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV. METHODS This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method. RESULTS Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance. CONCLUSION Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.
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Affiliation(s)
- Simon-Decap Mabakutuvangilanga Ntela
- Higher Institute of Medical Techniques of Kinshasa, Democratic Republic of Congo
- University of Paris 13, Sorbonne Paris Cite, Nursing Sciences Research chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
| | - Nathalie Goutte
- University Hospitals of South Paris, Paul Brousse Hospital, INSERM 1193, DHU Hépatinov, France
| | - Jean-Manuel Morvillers
- University of Paris 13, Sorbonne Paris Cite, Nursing Sciences Research chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
| | - Cyril Crozet
- University Paris 13, Sorbonne Paris Cite, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
| | - Mathieu Ahouah
- University of Paris 13, Sorbonne Paris Cite, Nursing Sciences Research chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
| | | | - Bernard Ntoto-Kunzi
- Higher Institute of Medical Techniques of Kinshasa, Democratic Republic of Congo
| | | | - Monique Rothan-Tondeur
- University of Paris 13, Sorbonne Paris Cite, Nursing Sciences Research chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
- Assistance Publique Hopitaux des paris (AP HP), Nursing Sciences Research chair Paris, France
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Pilgrim N, Jani N, Mathur S, Kahabuka C, Saria V, Makyao N, Apicella L, Pulerwitz J. Provider perspectives on PrEP for adolescent girls and young women in Tanzania: The role of provider biases and quality of care. PLoS One 2018; 13:e0196280. [PMID: 29702659 PMCID: PMC5922529 DOI: 10.1371/journal.pone.0196280] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/08/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Oral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub-Saharan Africa. However, health care providers' (HCPs) perspectives and interactions with potential clients can substantially influence effective provision of quality health services. We examine if HCPs' knowledge, attitude, and skills, as well as their perceptions of facility readiness to provide PrEP are associated with their willingness to provide PrEP to AGYW at high risk of HIV in Tanzania. METHODS A self-administered questionnaire was given to 316 HCPs from 74 clinics in two districts and 24 HCPs participated in follow-up in-depth interviews (IDIs). We conducted bivariate and multivariable Poisson regression to assess factors associated with willingness to provide PrEP to AGYW. Thematic content analysis was used to analyze the IDIs, which expanded upon the quantitative results. RESULTS Few HCPs (3.5%) had prior PrEP knowledge, but once informed, 61.1% were willing to prescribe PrEP to AGYW. Higher negative attitudes toward adolescent sexuality and greater concerns about behavioral disinhibition due to PrEP use were associated with lower willingness to prescribe PrEP. Qualitatively, HCPs acknowledged that biases, rooted in cultural norms, often result in stigmatizing and discriminatory care toward AGYW, a potential barrier for PrEP provision. However, better training to provide HIV services was associated with greater willingness to prescribe PrEP. Conversely, HCPs feared the potential negative impact of PrEP on the provision of existing HIV services (e.g., overburdened staff), and suggested the integration of PrEP into non-HIV services and the use of paramedical professionals to facilitate PrEP provision. CONCLUSIONS Preparing for PrEP introduction requires more than solely training HCPs on the clinical aspects of providing PrEP. It requires a two-pronged strategy: addressing HCPs' biases regarding sexual health services to AGYW; and preparing the health system infrastructure for the introduction of PrEP.
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Affiliation(s)
- Nanlesta Pilgrim
- Population Council, Washington, DC, United States of America
- * E-mail:
| | - Nrupa Jani
- Population Council, Washington, DC, United States of America
| | - Sanyukta Mathur
- Population Council, Washington, DC, United States of America
| | | | - Vaibhav Saria
- Population Council, Washington, DC, United States of America
| | - Neema Makyao
- National AIDS Control Programme, Dar es Salaam, Tanzania
| | - Lou Apicella
- Population Council, Washington, DC, United States of America
| | - Julie Pulerwitz
- Population Council, Washington, DC, United States of America
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Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc 2017; 20:21580. [PMID: 28691439 PMCID: PMC5515024 DOI: 10.7448/ias.20.1.21580] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: To facilitate provision of pre-exposure prophylaxis (PrEP) in low- and middle-income countries (LMIC), a better understanding of potential demand and user preferences is required. This review assessed awareness and willingness to use oral PrEP among men who have sex with men (MSM) in LMIC. Methods: Electronic literature search of Cochrane library, Embase, PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar was conducted between July and September 2016. Reference lists of relevant studies were searched, and three authors contacted for additional data. Non-peer reviewed publications were excluded. Studies were screened for inclusion, and relevant data abstracted, assessed for bias, and synthesized. Results: In total, 2186 records were identified, of which 23 studies involving 14,040 MSM from LMIC were included. The proportion of MSM who were aware of PrEP was low at 29.7% (95% CI: 16.9–44.3). However, the proportion willing to use PrEP was higher, at 64.4% (95% CI: 53.3–74.8). Proportions of MSM aware of PrEP was <50% in 11 studies and 50–70% in 3 studies, while willingness to use PrEP was <50% in 6 studies, 50–70% in 9 studies, and over 80% in 5 studies. Several factors affected willingness to use PrEP. At the individual domain, poor knowledge of PrEP, doubts about its effectiveness, fear of side effects, low perception of HIV risk, and the need to adhere or take medicines frequently reduced willingness to use PrEP, while PrEP education and motivation to maintain good health were facilitators of potential use. Demographic factors (education, age, and migration) influenced both awareness and willingness to use PrEP, but their effects were not consistent across studies. At the social domain, anticipated stigma from peers, partners, and family members related to sexual orientation, PrEP, or HIV status were barriers to potential use of PrEP, while partner, peer, and family support were facilitators of potential use. At the structural domain, concerns regarding attitudes of healthcare providers, quality assurance, data protection, and cost were determinants of potential use. Conclusions: This review found that despite low levels of awareness of PrEP, MSM in LMIC are willing to use it if they are supported appropriately to deal with a range of individual, social, and structural barriers.
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Chow EPF, Walker S, Hocking JS, Bradshaw CS, Chen MY, Tabrizi SN, Howden BP, Law MG, Maddaford K, Read TRH, Lewis DA, Whiley DM, Zhang L, Grulich AE, Kaldor JM, Cornelisse VJ, Phillips S, Donovan B, McNulty AM, Templeton DJ, Roth N, Moore R, Fairley CK. A multicentre double-blind randomised controlled trial evaluating the efficacy of daily use of antibacterial mouthwash against oropharyngeal gonorrhoea among men who have sex with men: the OMEGA (Oral Mouthwash use to Eradicate GonorrhoeA) study protocol. BMC Infect Dis 2017; 17:456. [PMID: 28659133 PMCID: PMC5490220 DOI: 10.1186/s12879-017-2541-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gonorrhoea is one of the most common sexually transmissible infections in men who have sex with men (MSM). Gonorrhoea rates have increased substantially in recent years. There is concern that increasing gonorrhoea prevalence will increase the likelihood of worsening antibiotic resistance in Neisseria gonorrhoeae. A recent randomised controlled trial (RCT) demonstrated that a single-dose of mouthwash has an inhibitory effect against oropharyngeal gonorrhoea. We are conducting the first RCT to evaluate whether daily use of mouthwash could reduce the risk of acquiring oropharyngeal gonorrhoea. METHODS/DESIGN The OMEGA (Oral Mouthwash use to Eradicate GonorrhoeA) study is a double-blind RCT and will be conducted at several sexual health clinics and high caseload General Practice (GP) clinics in Melbourne and Sydney, Australia. A total of 504 MSM attending the participating sites will be recruited. Participants will be randomised to either using 'Study mouthwash A' or 'Study mouthwash B' for 12 weeks. Study mouthwash A was inhibitory against N. gonorrhoeae in vitro, whereas study mouthwash B was not. Participants will be instructed to rinse and gargle the study mouthwash for 60 seconds every day. The primary outcome is the proportion of participants with oropharyngeal gonorrhoea detected by nucleic acid amplification test by 12 weeks. DISCUSSION The results from this trial may provide a novel way to reduce gonorrhoea prevalence and transmission without the use of antibiotics that may be associated with development of resistance. If shown to be effective, the widespread use of mouthwash will reduce the prevalence of oropharyngeal gonorrhoea, which plays key role in driving the emergence of gonococcal antimicrobial resistance through DNA exchange with oral commensal bacteria. The anticipated net effect will be interruption of onward transmission of N. gonorrhoeae within high density sexual networks within MSM populations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000247471 , registered on 23rd February 2016.
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Affiliation(s)
- Eric P. F. Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3053 Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
| | - Sepehr N. Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, VIC 3052 Australia
- Murdoch Childrens Research Institute, Parkville, VIC 3052 Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC 3052 Australia
| | - Benjamin P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010 Australia
| | - Matthew G. Law
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW 2150 Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
| | - Tim R. H. Read
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
| | - David A. Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW 2150 Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, The University of Sydney, Westmead, NSW 2145 Australia
| | - David M. Whiley
- Pathology Queensland Central Laboratory, QLD, Brisbane, 4029 Australia
- The University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital Campus, QLD, Herston, 4029 Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
| | | | | | - Vincent J. Cornelisse
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
- Prahran Market Clinic, Prahran, VIC 3181 Australia
| | - Samuel Phillips
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, VIC 3052 Australia
- Murdoch Childrens Research Institute, Parkville, VIC 3052 Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Kensington, NSW 2052 Australia
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000 Australia
| | - Anna M. McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000 Australia
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, NSW 2052 Australia
| | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Kensington, NSW 2052 Australia
- RPA Sexual Health, Community Health, Sydney Local Health District, Camperdown, NSW 2050 Australia
- Central Clinical School, The University of Sydney, Camperdown, NSW 2006 Australia
| | - Norman Roth
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000 Australia
| | | | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, VIC 3053 Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3004 Australia
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