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Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England.

Krakower DS, Oldenburg CE, Mitty JA, Wilson IB, Kurth AE, Maloney KM, Gallagher D, Mayer KH - PLoS ONE (2015)

Bottom Line: Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices.Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06-1.34), whereas female gender (aOR 0.26, 95% CI 0.10-0.71) was associated with having not prescribed PrEP.These findings suggest many clinicians have shifted towards routinely recommending early ART, but not PrEP, so interventions to facilitate PrEP provision are needed.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America; The Fenway Institute, Boston, Massachusetts, United States of America.

ABSTRACT

Background: Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited.

Methods: Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices.

Results: Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01-1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98-11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06-1.34), whereas female gender (aOR 0.26, 95% CI 0.10-0.71) was associated with having not prescribed PrEP.

Conclusions: These findings suggest many clinicians have shifted towards routinely recommending early ART, but not PrEP, so interventions to facilitate PrEP provision are needed.

No MeSH data available.


Related in: MedlinePlus

Clinician beliefs and reported practices regarding early antiretroviral treatment (n = 105), New England, 2013.Participants were presented with statements about early antiretroviral treatment and asked to indicate their degree of agreement (strongly agree, agree, disagree, strongly disagree). Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, whereas red shading represents disagreement. Data are restricted to clinicians who have prescribed antiretroviral therapy to at least 1 HIV-infected patient in the prior year.
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pone.0132398.g001: Clinician beliefs and reported practices regarding early antiretroviral treatment (n = 105), New England, 2013.Participants were presented with statements about early antiretroviral treatment and asked to indicate their degree of agreement (strongly agree, agree, disagree, strongly disagree). Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, whereas red shading represents disagreement. Data are restricted to clinicians who have prescribed antiretroviral therapy to at least 1 HIV-infected patient in the prior year.

Mentions: Survey domains relating to early ART included knowledge of guideline recommendations, beliefs, prescribing intentions and practices, and experiences discussing early ART with patients. Knowledge was measured by asking participants to indicate whether or not DHHS guidelines recommended ART for all HIV-infected patients irrespective of CD4+ count (true, false, not sure). Beliefs were assessed by agreement (strongly agree, agree, disagree, strongly disagree) to 10 statements about the effectiveness and potential harms of early ART and patient and practice-level factors that could influence prescribing decisions [12] (Fig 1). Intentions to prescribe early ART to patients with various CD4+ counts and co-occurring medical conditions were measured through 10 brief patient scenarios [12]. For these 10 scenarios, participants were asked, “In which of the following scenarios would you generally recommend that ART be initiated for a typical HIV-infected patient?” Scenarios included patients with CD4+ count ≤200 cells/mm3, ≤350 cells/mm3, ≤500 cells/mm3, or all patients irrespective of CD4+ count, and patients with chronic hepatitis B, hepatitis C, HIV-associated nephropathy, HIV-associated dementia, pregnancy, or those receiving tuberculosis treatment, all irrespective of CD4+ count. Experiences with discussing early ART were assessed by asking clinicians to indicate, for patients with CD4+ count > 500 cells/μL, how frequently they recommended ART, whether patients objected to ART, and whether practitioners attempted to persuade objecting patients to initiate ART (always, often, sometimes, rarely, never, not applicable).


Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England.

Krakower DS, Oldenburg CE, Mitty JA, Wilson IB, Kurth AE, Maloney KM, Gallagher D, Mayer KH - PLoS ONE (2015)

Clinician beliefs and reported practices regarding early antiretroviral treatment (n = 105), New England, 2013.Participants were presented with statements about early antiretroviral treatment and asked to indicate their degree of agreement (strongly agree, agree, disagree, strongly disagree). Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, whereas red shading represents disagreement. Data are restricted to clinicians who have prescribed antiretroviral therapy to at least 1 HIV-infected patient in the prior year.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492498&req=5

pone.0132398.g001: Clinician beliefs and reported practices regarding early antiretroviral treatment (n = 105), New England, 2013.Participants were presented with statements about early antiretroviral treatment and asked to indicate their degree of agreement (strongly agree, agree, disagree, strongly disagree). Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, whereas red shading represents disagreement. Data are restricted to clinicians who have prescribed antiretroviral therapy to at least 1 HIV-infected patient in the prior year.
Mentions: Survey domains relating to early ART included knowledge of guideline recommendations, beliefs, prescribing intentions and practices, and experiences discussing early ART with patients. Knowledge was measured by asking participants to indicate whether or not DHHS guidelines recommended ART for all HIV-infected patients irrespective of CD4+ count (true, false, not sure). Beliefs were assessed by agreement (strongly agree, agree, disagree, strongly disagree) to 10 statements about the effectiveness and potential harms of early ART and patient and practice-level factors that could influence prescribing decisions [12] (Fig 1). Intentions to prescribe early ART to patients with various CD4+ counts and co-occurring medical conditions were measured through 10 brief patient scenarios [12]. For these 10 scenarios, participants were asked, “In which of the following scenarios would you generally recommend that ART be initiated for a typical HIV-infected patient?” Scenarios included patients with CD4+ count ≤200 cells/mm3, ≤350 cells/mm3, ≤500 cells/mm3, or all patients irrespective of CD4+ count, and patients with chronic hepatitis B, hepatitis C, HIV-associated nephropathy, HIV-associated dementia, pregnancy, or those receiving tuberculosis treatment, all irrespective of CD4+ count. Experiences with discussing early ART were assessed by asking clinicians to indicate, for patients with CD4+ count > 500 cells/μL, how frequently they recommended ART, whether patients objected to ART, and whether practitioners attempted to persuade objecting patients to initiate ART (always, often, sometimes, rarely, never, not applicable).

Bottom Line: Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices.Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06-1.34), whereas female gender (aOR 0.26, 95% CI 0.10-0.71) was associated with having not prescribed PrEP.These findings suggest many clinicians have shifted towards routinely recommending early ART, but not PrEP, so interventions to facilitate PrEP provision are needed.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America; The Fenway Institute, Boston, Massachusetts, United States of America.

ABSTRACT

Background: Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited.

Methods: Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices.

Results: Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01-1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98-11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06-1.34), whereas female gender (aOR 0.26, 95% CI 0.10-0.71) was associated with having not prescribed PrEP.

Conclusions: These findings suggest many clinicians have shifted towards routinely recommending early ART, but not PrEP, so interventions to facilitate PrEP provision are needed.

No MeSH data available.


Related in: MedlinePlus