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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

Clinicians’ perceived barriers to prescribing pre-exposure prophylaxis (n = 155), New England, 2013.Numbers within bars represent the percentage of participants selecting each response category. Data are restricted to clinicians from specialties for which PrEP prescribing may be feasible, i.e., those that involve provision of longitudinal medical care.
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pone.0132398.g003: Clinicians’ perceived barriers to prescribing pre-exposure prophylaxis (n = 155), New England, 2013.Numbers within bars represent the percentage of participants selecting each response category. Data are restricted to clinicians from specialties for which PrEP prescribing may be feasible, i.e., those that involve provision of longitudinal medical care.

Mentions: Participants perceived numerous practical barriers to prescribing PrEP, including lack of patient requests for PrEP, concerns about insurance coverage, and limited practitioner training in PrEP provision, among other barriers (Fig 3).


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)

Clinicians’ perceived barriers to prescribing pre-exposure prophylaxis (n = 155), New England, 2013.Numbers within bars represent the percentage of participants selecting each response category. Data are restricted to clinicians from specialties for which PrEP prescribing may be feasible, i.e., those that involve provision of longitudinal medical care.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132398.g003: Clinicians’ perceived barriers to prescribing pre-exposure prophylaxis (n = 155), New England, 2013.Numbers within bars represent the percentage of participants selecting each response category. Data are restricted to clinicians from specialties for which PrEP prescribing may be feasible, i.e., those that involve provision of longitudinal medical care.
Mentions: Participants perceived numerous practical barriers to prescribing PrEP, including lack of patient requests for PrEP, concerns about insurance coverage, and limited practitioner training in PrEP provision, among other barriers (Fig 3).

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