Abstract
BackgroundNonoccupational postexposure prophylaxis (nPEP) is an effective HIV biomedical prevention strategy. The research and use of nPEP are mainly concentrated in the developed world, while little is known about the knowledge, attitudes, and practices of nPEP among HIV medical care providers in developing countries.ObjectiveWe aimed to assess the nPEP knowledge and prescribing practice among HIV medical care providers in mainland China.MethodsHIV medical care providers were recruited in China during May and June 2019 through an online survey regarding nPEP-related knowledge, attitudes, and clinical prescription experiences. Multivariable logistic regression was performed to identify factors associated with prescribing nPEP among HIV medical care providers.ResultsA total of 777 eligible participants participated in this study from 133 cities in 31 provinces in China. Of the participants, 60.2% (468/777) were unfamiliar with nPEP and only 53.3% (414/777) of participants ever prescribed nPEP. HIV care providers who worked in a specialized infectious disease hospital (vs general hospital, adjusted odds ratio [aOR] 2.49; 95% CI 1.85-3.37), had practiced for 6-10 years (vs 5 or fewer years, aOR 3.28; 95% CI 2.23-4.80), had practiced for 11 years or more (vs 5 or fewer years, aOR 3.75; 95% CI 2.59-5.45), and had previously prescribed occupational PEP (oPEP, aOR 4.90; 95% CI 3.29-7.29) had a significantly positive association with prescribing nPEP. However, unfamiliarity with nPEP (aOR 0.08; 95% CI 0.05-0.11), believing nPEP may promote HIV high-risk behavior (aOR 0.53; 95% CI 0.36-0.77) or result in HIV drug resistance (aOR 0.53; 95% CI 0.36-0.77) among key populations, and self-reported having no written oPEP guideline in place (aOR 0.53; 95% CI 0.35-0.79) were negatively associated with nPEP prescription behavior.ConclusionsHIV medical care providers have insufficient nPEP knowledge and an inadequate proportion of prescribing, which may impede the scale-up of nPEP services to curb HIV acquisition. The implementation of tailored nPEP training or retraining to HIV medical care providers would improve this situation.
Highlights
HIV Epidemic in Key PopulationsThe Joint United Nations Program on HIV/AIDS (UNAIDS) and World Health Organization (WHO) estimate that 38 million people were living with HIV in 2019, with over two-thirds concentrated in low-income developing countries [1,2]
HIV medical care providers have insufficient Nonoccupational postexposure prophylaxis (nPEP) knowledge and an inadequate proportion of prescribing, which may impede the scale-up of nPEP services to curb HIV acquisition
≤5 6-10 ≥11 Unfamiliar with oPEPd Yes No Unfamiliar with nPEP Yes No Do you think China has issued a national clinical guideline on nPEP? Yes No I don’t know Do you think UAIe exposure risk between males exceeds percutaneous occupational exposure risk? Yes No I don’t know Do you think percutaneous occupational exposure risk exceeds UVIf exposure risk? Yes No I don’t know anPEP: nonoccupational postexposure prophylaxis. bnPEP pilot programs were conducted by China CDC in provinces Yunnan, Beijing, Tianjin, Heilongjiang, Hunan, Guangxi, and Guizhou. cLocal HIV epidemic level was categorized according to the number of HIV/AIDS cases reported in 2017. doPEP: occupational postexposure prophylaxis. eUAI: unprotected anal intercourse. fUVI: unprotected vaginal intercourse
Summary
The Joint United Nations Program on HIV/AIDS (UNAIDS) and World Health Organization (WHO) estimate that 38 million people were living with HIV in 2019, with over two-thirds concentrated in low-income developing countries [1,2]. The epidemic of HIV is concentrated in key populations [3], including men who have sex with men (MSM) [4,5]. Nonoccupational postexposure prophylaxis (nPEP) is an effective and cost-effective HIV biomedical prevention strategy [9,10]. NPEP services are not widely used in most developing countries with relatively severe HIV epidemics, even though some have released their own guidelines. Nonoccupational postexposure prophylaxis (nPEP) is an effective HIV biomedical prevention strategy. The research and use of nPEP are mainly concentrated in the developed world, while little is known about the knowledge, attitudes, and practices of nPEP among HIV medical care providers in developing countries
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