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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 regarding pre-exposure prophylaxis (n = 181), New England, 2013.Participants indicated their degree of agreement (strongly agree, agree, neutral, disagree, strongly disagree) to statements about pre-exposure prophylaxis. Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, neutral shading represents neutrality, and red shading represents disagreement.
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pone.0132398.g002: Clinician beliefs regarding pre-exposure prophylaxis (n = 181), New England, 2013.Participants indicated their degree of agreement (strongly agree, agree, neutral, disagree, strongly disagree) to statements about pre-exposure prophylaxis. Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, neutral shading represents neutrality, and red shading represents disagreement.

Mentions: Almost all of the respondents believed that PrEP was effective (only 6% strongly agreed or agreed that PrEP was not effective; Fig 2). However, substantial proportions of clinicians were concerned that PrEP use could potentially be associated with side effects, drug resistance, or increased risk behaviors. One-third of practitioners thought that behavioral interventions should be utilized before PrEP. Some participants believed PrEP provision would be more feasible in primary care settings or STD clinics than clinics specializing in HIV care.


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 regarding pre-exposure prophylaxis (n = 181), New England, 2013.Participants indicated their degree of agreement (strongly agree, agree, neutral, disagree, strongly disagree) to statements about pre-exposure prophylaxis. Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, neutral shading represents neutrality, and red shading represents disagreement.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132398.g002: Clinician beliefs regarding pre-exposure prophylaxis (n = 181), New England, 2013.Participants indicated their degree of agreement (strongly agree, agree, neutral, disagree, strongly disagree) to statements about pre-exposure prophylaxis. Numbers within bars represent the percentage of respondents selecting each response category. Blue shading represents agreement, neutral shading represents neutrality, and red shading represents disagreement.
Mentions: Almost all of the respondents believed that PrEP was effective (only 6% strongly agreed or agreed that PrEP was not effective; Fig 2). However, substantial proportions of clinicians were concerned that PrEP use could potentially be associated with side effects, drug resistance, or increased risk behaviors. One-third of practitioners thought that behavioral interventions should be utilized before PrEP. Some participants believed PrEP provision would be more feasible in primary care settings or STD clinics than clinics specializing in HIV care.

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