Attitude towards antiretroviral pre-exposure prophylaxis (PrEP) prescription among HIV specialists

BMC Infectious Diseases

Giuseppe Ippolito²  Pierluca Piselli¹  Gabriella De Carli¹  Antonio Palummieri¹  Vincenzo Puro¹ 

[1] UOC Infezioni emergenti e Centro di riferimento AIDS - Department of Epidemiology, National Institute for Infectious Diseases “Lazzaro Spallanzani” – IRCCS, via Portuense, 292, 00161, Rome, Italy;Scientific Direction, National Institute for Infectious Diseases “Lazzaro Spallanzani” – IRCCS, Rome, Italy

关键词: Health knowledge, Attitudes, Practice;    HIV healthcare providers;    HIV prevention;    Antiretroviral drugs;    HIV pre-exposure prophylaxis;   

Others  :  1148398
DOI  :  10.1186/1471-2334-13-217

 received in 2012-12-21, accepted in 2013-05-09,  发布年份 2013

【 摘 要 】

Background

To investigate perceptions and attitude to prescribe Pre-Exposure Prophylaxis (PrEP) among HIV specialists.

Methods

A 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.

Results

Of 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.

Conclusions

Although 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.

【 授权许可】

   
2013 Puro et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Padian NS, McCoy SI, Karim SS, Hasen N, Kim J, Bartos M, Katabira E, Bertozzi SM, Schwartländer B, Cohen MS: HIV prevention transformed: the new prevention research agenda. Lancet 2011, 378:269-278.
• [2]Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ: The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011, 52:793-800.
• [3]Fleishman JA, Yehia BR, Moore RD, Korthuis PT, Gebo KA, HIV Research Network: Establishment, retention, and loss to follow-up in outpatient HIV care. J Acquir Immune Defic Syndr 2012, 60:249-259.
• [4]Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, Kharsany AB, Sibeko S, Mlisana KP, Omar Z, Gengiah TN, Maarschalk S, Arulappan N, Mlotshwa M, Morris L, Taylor D, CAPRISA 004 Trial Group: Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science 2010, 329:1168-1174.
• [5]Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker LG, Mayer KH, Kallás EG, Amico KR, Mulligan K, Bushman LR, Hance RJ, Ganoza C, Defechereux P, Postle B, Wang F, McConnell JJ, Zheng JH, Lee J, Rooney JF, Jaffe HS, Martinez AI, Burns DN, Glidden DV, iPrEx Study Team: Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010, 363:2587-2599.
• [6]Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, Nakku-Joloba E, Twesigye R, Ngure K, Apaka C, Tamooh H, Gabona F, Mujugira A, Panteleeff D, Thomas KK, Kidoguchi L, Krows M, Revall J, Morrison S, Haugen H, Emmanuel-Ogier M, Ondrejcek L, Coombs RW, Frenkel L, Hendrix C, Bumpus NN, Bangsberg D, Haberer JE, Stevens WS, Lingappa JR, Celum C, Partners PrEP Study Team: Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012, 367:399-410.
• [7]Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, Henderson FL, Pathak SR, Soud FA, Chillag KL, Mutanhaurwa R, Chirwa LI, Kasonde M, Abebe D, Buliva E, Gvetadze RJ, Johnson S, Sukalac T, Thomas VT, Hart C, Johnson JA, Malotte CK, Hendrix CW, Brooks JT, TDF2 Study Group: Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012, 367:423-434.
• [8]Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, Malahleha M, Owino F, Manongi R, Onyango J, Temu L, Monedi MC, Mak’Oketch P, Makanda M, Reblin I, Makatu SE, Saylor L, Kiernan H, Kirkendale S, Wong C, Grant R, Kashuba A, Nanda K, Mandala J, Fransen K, Deese J, Crucitti T, Mastro TD, Taylor D, FEM-PrEP Study Group: Preexposure prophylaxis for HIV infection among African women. N Engl J Med 2012, 367:411-422.
• [9]van der Straten A, Van Damme L, Haberer JE, Bangsberg DR: Unraveling the divergent results of pre-exposure prophylaxis trials for HIV prevention. AIDS 2012, 26:F13-F19.
• [10]National Institute of Allergy and Infectious Diseases (NIAID): NIH modifies ‘VOICE’ HIV prevention study in women. National Institutes of Health; http://www.nih.gov/news/health/sep2011/niaid-28.htm webcite
• [11]Ministry of Health: Linee Guida Italiane sull’utilizzo dei farmaci antiretrovirali e sulla gestione diagnostico-clinica delle persone con infezione da HIV-1. Luglio. 2012. [http://www.salute.gov.it/imgs/C_17_pubblicazioni_1793_allegato.pdf webcite]
• [12]Puro V, De Carli G, Schifano E, Piselli P, Orchi N, Pittalis S, Scognamiglio P, Cimaglia C, Agresta A, Ippolito G, Italian Registry of Antireroviral PEP: HIV post-exposure prophylaxis in Italy (1996–2009) [abstract]. Infection 2011, Suppl 1:S15-S16.
• [13]Tripathi A, Ogbuanu C, Monger M, Gibson JJ, Duffus WA: Preexposure prophylaxis for HIV infection: healthcare providers’ knowledge, perception, and willingness to adopt future implementation in the southern US. South Med J 2012, 105:199-206.
• [14]O’Brien K: Using focus groups to develop health surveys: an example from research on social relationships and AIDS-preventive behavior. Health Educ Behav 1993, 20:361-372.
• [15]White JM, Mimiaga MJ, Krakower DS, Mayer KH: Evolution of Massachusetts physician attitudes, knowledge, and experience regarding the use of antiretrovirals for HIV prevention. AIDS Patient Care STDs 2012, 26:395-405.
• [16]Hosmer DW, Lemeshow S: Applied logistic regression. New York, NY: Wiley; 1989.
• [17]Mammone A, Pezzotti P, Angeletti C, Orchi N, Carboni A, Navarra A, Sciarrone MR, Sias C, Puro V, Guasticchi G, Ippolito G, Borgia P, Girardi E, SENDIH Study Group: HIV incidence estimate combining HIV/AIDS surveillance, testing history information and HIV test to identify recent infections in Lazio, Italy. BMC Infect Dis 2012, 12:65. BioMed Central Full Text
• [18]Suligoi B, Boros S, Camoni L, Camoni L, Pugliese L: Aggiornamento delle nuove diagnosi di infezione da HIV al 31 dicembre 2009 e dei casi di AIDS in Italia al 31 dicembre 2010. Not Ist Super Sanità 2011, Suppl 1:3-27.
• [19]Suligoi B, Raimondo M, Fanales-Belasio E, Buttò S: The epidemic of HIV infection and AIDS, promotion of testing, and innovative strategies. Ann Ist Super Sanita 2010, 46:15-23.
• [20]Arnold EA, Hazelton P, Lane T, Christopoulos KA, Galindo GR, Steward WT, Morin SF: A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS One 2012, 7:e40603.
• [21]Schackman BR, Eggman AA: Cost-effectiveness of pre-exposure prophylaxis for HIV: a review. Curr Opin HIV AIDS 2012, 7:587-592.
• [22]Puro V, De Carli G, Piselli P, Sciarrone MR, Schifano E, Pittalis S, Ippolito G: HIV incidence among men who have sex with men prescribed postexposure prophylaxis. AIDS 2012, 26:1581-1583.
• [23]International Association of Physicians in AIDS Care: Controlling the HIV epidemic with antiretrovirals: treatment as prevention and pre-exposure prophylaxis. IAPAC consensus statement. 2012. [http://www.iapac.org/tasp_prep/assets/TPSlon12_consensus.pdf webcite]
• [24]Centers for Disease Control and Prevention: Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR 2011, 60:65-68.
• [25]McCormack S, Fidler S, Fisher M, British HIV, Association, British Association for Sexual Health and HIV: The British HIV association/British association for sexual health and HIV position statement on pre-exposure prophylaxis in the UK. Int J STD AIDS 2012, 23:1-4.
• [26]U.S. Food and Drug Administration: FDA approves first drug for reducing the risk of sexually acquired HIV infection. [http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm webcite]
• [27]World Health Organization: Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV Recommendations for use in the context of demonstration projects. 2012. [http://www.who.int/hiv/pub/guidance_prep/en/ webcite]
• [28]Centers for Disease Control and Prevention: Interim guidance for health-care providers electing to provide preexposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) infection in heterosexually active adults who are at ongoing, very high risk for sexual acquisition of HIV infection. MMWR 2012, 61:586-589.
• [29]European Medicines Agency: Reflection paper on the non-clinical and clinical development for oral and topical HIV pre-exposure prophylaxis (PrEP). [http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2012/03/WC500124054.pdf webcite]
• [30]AIDS Vaccine Advocacy Coalition: Ongoing PrEP trials. [http://data.avac.org/OngoingPrEPTrials.aspx webcite]
• [31]Metzger DS, Koblin B, Turner C, Navaline H, Valenti F, Holte S, Gross M, Sheon A, Miller H, Cooley P, Seage GR: Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET vaccine preparedness study protocol team. Am J Epidemiol 2000, 152:99-106.
• [32]Krakower DS, Mimiaga MJ, Rosenberger JG, Novak DS, Mitty JA, White JM, Mayer KH: Limited awareness and Low immediate uptake of Pre-exposure prophylaxis among Men Who have Sex with Men using an internet social networking site. PLoS One 2012, 7:e33119.
• [33]Mayer KH, Safren SA, Gordon CM: HIV care providers and prevention: opportunities and challenges. J Acquir Immune Defic Syndr 2004, Suppl 2:S130-S132.
• [34]Lindley LL, Coleman JD, Gaddist BW, White J: Informing faith-based HIV/AIDS interventions: HIV-related knowledge and stigmatizing attitudes at Project F.A.I.T.H. churches in South Carolina. Public Health Rep 2010, Suppl 1:12-20.
• [35]Colbert JA: Clinical decisions. Preexposure prophylaxis for HIV prevention-polling results. N Engl J Med 2012, 367:e22.