The Acceptability of Pre-Exposure Prophylaxis: Beliefs of Health-Care Professionals Working in Sexually Transmitted Infections Clinics and HIV Treatment Centers.

Janneke P. Bil,Maria Prins,Udi Davidovich,Henry J. C. de Vries,Elske Hoornenborg,Arjan Hogewoning,Fernando Dias Goncalves Lima

doi:10.3389/fpubh.2018.00005

Abstract

Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV infections, but is not yet implemented in the Netherlands. As the attitudes of health-care professionals toward PrEP can influence future PrEP implementation, we studied PrEP knowledge and beliefs and their association with PrEP acceptability among professionals in clinics for sexually transmitted infection (STI professionals) and HIV treatment centers (HIV specialists). In addition, we examined preferred regimens, attitudes toward providing PrEP to key populations and to reimbursement of PrEP costs. An online questionnaire was distributed among 24 public health STI clinics and 27 HIV treatment centers nationwide in the Netherlands between January and August 2015. The acceptability of PrEP was measured on a 7-point Likert scale ranging from 1 = low to 7 = high acceptability. Univariable and multivariable linear regression analyses were used to explore associations between demographic characteristics, PrEP knowledge, beliefs about PrEP, and PrEP acceptability. In total, 209 people (143 STI professionals and 66 HIV specialists) completed the questionnaire. The mean acceptability of PrEP implementation was 4.28 (SD 1.68) among STI professionals and 4.42 (SD 1.67) among HIV specialists. The mean score on self-perceived knowledge related to PrEP efficacy was 3.90 (SD 1.57) among STI professionals and 5.68 (SD 1.08) among HIV specialists (p-value of <0.001). Beliefs associated with lower PrEP acceptability among both groups were the fear that PrEP use will lead to a decrease in condom use and an increase in STI, the high costs of PrEP and ethical issues regarding prescribing antiretroviral medication to healthy individuals. No preference for a daily or an event-driven regimen was detected. Most participants deemed the following groups to be eligible for PrEP: men who have sex with men (MSM) who regularly get post-exposure prophylaxis, MSM who never used condoms with casual partners and MSM with an HIV-positive partner with a detectable viral load. Over half of the participants indicated that PrEP users should partly (54.1%) or fully (35.4%) pay the costs of PrEP. In 2015, PrEP acceptability was only moderate among Dutch STI professionals and HIV specialists, which is far from an optimal setting. Addressing barriers to PrEP acceptability in educational programs for various types of health-care professionals is needed to successfully implement PrEP in the Netherlands.

Highlights

Pre-exposure prophylaxis (PrEP) entails offering a regime of lower-intensity antiretroviral therapy (ART) to HIV-negative individuals to reduce their risk of HIV infection
A modeling study based on Dutch data estimated that 30% of new HIV infections could have been averted if half of all men who have sex with men (MSM) under 30 had received PrEP in combination with immediate ART for those who test positive [9]
Beliefs associated with a higher PrEP acceptability among all HIV specialists were “PrEP is an effective intervention to prevent HIV” (β = 0.49, p = 0.023) and “PrEP is a good addition to prevention strategies” (β = 0.28, p = 0.040)

Summary

Introduction

Pre-exposure prophylaxis (PrEP) entails offering a regime of lower-intensity antiretroviral therapy (ART) to HIV-negative individuals to reduce their risk of HIV infection. PrEP implementation was estimated to be cost-effective in the Netherlands over a 30-year time frame if PrEP was provided to the 10% most sexually active MSM [10]. Despite these results and the July 2016 approval of Truvada (emtricitabine/tenofovir disoproxil) for PrEP in the European Union, PrEP is not yet routinely available or reimbursed in the Netherlands. Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV infections, but is not yet implemented in the Netherlands. We examined preferred regimens, attitudes toward providing PrEP to key populations and to reimbursement of PrEP costs

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