Abstract
BackgroundTo investigate perceptions and attitude to prescribe Pre-Exposure Prophylaxis (PrEP) among HIV specialists.MethodsA questionnaire developed through a Focus Group and literature review was administered to a convenience sample of HIV specialists during educational courses in two Regions and an online survey in February-May 2012. Participants were classified as having a positive or negative attitude according to their willingness to prescribe PrEP. Demographic and working information, experience with HIV-infected patients, information and provision of antiretrovirals to uninfected persons, self-reported knowledge, perceptions and concerns regarding PrEP were assessed. The association between a different attitude towards PrEP prescription and selected characteristics was assessed through univariate and multivariate regression analysis.ResultsOf 311 specialists, 70% would prescribe PrEP, mainly to serodiscordant partners (64%) but also to people at ongoing, high risk of HIV infection (56%); 66% advocated public support of costs. A negative attitude towards PrEP was significantly associated with lack of provision of information on, and prescription of, antiretroviral post-exposure prophylaxis; specialists with a negative attitude believed behavioural interventions to be more effective than PrEP and were more concerned about toxicity. Overall, 90% of specialists disagreed regarding a lack of time for engaging in prevention counselling and PrEP monitoring; 79% would welcome formal guidelines, while those with a negative attitude did not consider this advisable.ConclusionsAlthough conflicting attitudes appear evident, most specialists seem to be willing, with guidance from normative bodies, to promote PrEP within multiple prevention strategies among vulnerable populations. More scientific evidence regarding effectiveness could overcome resistance.
Highlights
To investigate perceptions and attitude to prescribe Pre-Exposure Prophylaxis (PrEP) among HIV specialists
The impressive improvements in the treatability of HIV infection have not been paralleled by remarkable improvements in the effectiveness of HIV prevention strategies; more successful approaches are urgently needed
The specialists did not find an agreement on PrEP target populations
Summary
To investigate perceptions and attitude to prescribe Pre-Exposure Prophylaxis (PrEP) among HIV specialists. The impressive improvements in the treatability of HIV infection have not been paralleled by remarkable improvements in the effectiveness of HIV prevention strategies; more successful approaches are urgently needed. Biomedical prevention strategies include using antiretrovirals (ARV) treatment as prevention (TasP), i.e. treating HIV-infected patients, regardless of clinical status, to curb transmission. The use of ARV for pre-exposure prophylaxis (PrEP) among high-risk persons without HIV is emerging as one additional strategy to curtail the HIV epidemic. It seems necessary to understand the point of view of the providers on the actual implementation of PrEP in their clinical context, as well as to investigate how PrEP will be perceived by the communities of individuals at high risk
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