Physicians’ preparedness for pre-exposure prophylaxis: results of an online survey in Belgium
Thijs Reyniers
A G , Bea Vuylsteke A , Benoit Pirotte B , Elske Hoornenborg C D , Janneke P. Bil C , Kristien Wouters E , Marie Laga A and Christiana Nöstlinger A F
A Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
B Department of Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, Boulevard du Douzième de Ligne 1, 4000 Liège, Belgium.
C Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.
D Department of STI Outpatient Clinic, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands.
E Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
F Department of Applied Psychology, Faculty of Psychology, University of Vienna, Universitätsring 1, 1010 Vienna, Austria.
G Corresponding author. Email: treyniers@itg.be
Sexual Health 15(6) 606-611 https://doi.org/10.1071/SH18072
Submitted: 6 April 2018 Accepted: 27 September 2018 Published: 2 November 2018
Abstract
Background: Physicians have a crucial role in the implementation and scale up of pre-exposure prophylaxis (PrEP). The objective of this study is to examine Belgian physicians’ PrEP knowledge, concerns, acceptance and their willingness to prescribe PrEP. Methods: A cross-sectional online survey was conducted between March and June 2016. Dissemination targeted Belgian primary care physicians (PCPs) and HIV specialists. Sociodemographic characteristics, experience with HIV and PrEP, self-assessed PrEP knowledge, concerns about PrEP, and PrEP acceptance were stratified according to professional background. Associations with willingness to prescribe PrEP were examined using univariable and multivariable binary logistic regression analyses. Results: In total, 333 completed surveys were included in the analysis. Sixty-two physicians (18.6%) scored their knowledge of PrEP to be good, 263 (79.0%) had an accepting attitude towards PrEP and 198 (59.5%) were willing to prescribe PrEP if approved in Belgium. HIV specialists consistently reported having better knowledge of PrEP, less concerns and a more accepting attitude towards PrEP than PCPs. In multivariable logistic regression analysis, higher PrEP knowledge (OR 2.4; 95%CI: 1.0–5.7) and higher PrEP acceptance (OR: 3.8; 95%CI: 2.1–6.8) remained significantly associated with the willingness to prescribe PrEP. Conclusions: HIV specialists are better prepared to provide PrEP than PCPs in Belgium. Interventions to improve PrEP knowledge and acceptance among all providers are needed. The role of PCPs could be very important in optimising the rollout of PrEP, but additional training and guidelines will be needed.
Additional keywords: family physicians, HIV prevention, HIV specialists, primary care physician.
References
[1] Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, Rodolph M, Hodges-Mameletzis I, Grant RM. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS 2016; 30 1973–83.| Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.Crossref | GoogleScholarGoogle Scholar |
[2] 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 2587–99.
| Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[3] AIDS Vaccine Advocacy Coalition (AVAC). PrEPWatch Country updates. New York: AVAC; 2017. Available online at: http://www.prepwatch.org/scaling-up/country-updates/# [verified 21 February 2018].
[4] Vuylsteke B, Reyniers T, Lucet C, Nöstligner C, Deblonde J, Libois A, Sauvage AS, Deprez E, Goffard JC, Allard SD, Florence E, Demeester R, Callens S, Laga M. High uptake of pre-exposure prophylaxis (PrEP) during early roll-out in Belgium: results from surveillance reports. Sex Health 2018;
| High uptake of pre-exposure prophylaxis (PrEP) during early roll-out in Belgium: results from surveillance reports.Crossref | GoogleScholarGoogle Scholar |
[5] Krakower DS, Mayer KH. The role of healthcare providers in the roll out of preexposure prophylaxis. Curr Opin HIV AIDS 2016; 11 41–48.
| The role of healthcare providers in the roll out of preexposure prophylaxis.Crossref | GoogleScholarGoogle Scholar |
[6] Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS Behav 2017; 21 1256–67.
| PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists.Crossref | GoogleScholarGoogle Scholar |
[7] Krakower D, Ware N, Mitty JA, Maloney K, Mayer KH. HIV providers’ perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study. AIDS Behav 2014; 18 1712–21.
| HIV providers’ perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[8] Krakower D, Mayer KH. Engaging healthcare providers to implement HIV pre-exposure prophylaxis. Curr Opin HIV AIDS 2012; 7 593–9.
| Engaging healthcare providers to implement HIV pre-exposure prophylaxis.Crossref | GoogleScholarGoogle Scholar |
[9] Tellalian D, Maznavi K, Bredeek UF, Hardy WD. Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices. AIDS Patient Care STDS 2013; 27 553–9.
| Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices.Crossref | GoogleScholarGoogle Scholar |
[10] Karris MY, Beekmann SE, Mehta SR, Anderson CM, Polgreen PM. Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada. Clin Infect Dis 2014; 58 704–12.
| Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada.Crossref | GoogleScholarGoogle Scholar |
[11] Puro V, Palummieri A, De Carli G, Piselli P, Ippolito G. Attitude towards antiretroviral pre-exposure prophylaxis (PrEP) prescription among HIV specialists. BMC Infect Dis 2013; 13 217
| Attitude towards antiretroviral pre-exposure prophylaxis (PrEP) prescription among HIV specialists.Crossref | GoogleScholarGoogle Scholar |
[12] Blackstock OJ, Moore BA, Berkenblit GV, Calabrese SK, Cunningham CO, Fiellin DA, Patel VV, Phillips KA, Tetrault JM, Shah M, Edelman EJ. A cross-sectional online survey of HIV pre-exposure prophylaxis adoption among primary care physicians. J Gen Intern Med 2017; 32 62–70.
| A cross-sectional online survey of HIV pre-exposure prophylaxis adoption among primary care physicians.Crossref | GoogleScholarGoogle Scholar |
[13] Conniff J, Evensen A. Preexposure prophylaxis (PrEP) for HIV prevention: the primary care perspective. J Am Board Fam Med 2016; 29 143–51.
| Preexposure prophylaxis (PrEP) for HIV prevention: the primary care perspective.Crossref | GoogleScholarGoogle Scholar |
[14] Krakower D, Mayer KH. What primary care providers need to know about preexposure prophylaxis for HIV prevention. Ann Intern Med 2012; 157 490–7.
| What primary care providers need to know about preexposure prophylaxis for HIV prevention.Crossref | GoogleScholarGoogle Scholar |
[15] Walsh JL, Petroll AE. Factors related to pre-exposure prophylaxis prescription by U.S. primary care physicians. Am J Prev Med 2017; 52 e165–72.
| Factors related to pre-exposure prophylaxis prescription by U.S. primary care physicians.Crossref | GoogleScholarGoogle Scholar |
[16] Blumenthal J, Jain S, Krakower D, Sun X, Young J, Mayer K, Haubrich R, the CCTG 598 Team . Knowledge is power! Increased provider knowledge scores regarding pre-exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP. AIDS Behav 2015; 19 802–10.
| Knowledge is power! Increased provider knowledge scores regarding pre-exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP.Crossref | GoogleScholarGoogle Scholar |
[17] Bil JP, Hoornenborg E, Prins M, Hogewoning A, Dias Goncalves Lima F, de Vries HJC, Davidovich U. The acceptability of pre-exposure prophylaxis: beliefs of health-care professionals working in sexually transmitted infections clinics and HIV treatment centers. Front Public Health 2018; 6 5
| The acceptability of pre-exposure prophylaxis: beliefs of health-care professionals working in sexually transmitted infections clinics and HIV treatment centers.Crossref | GoogleScholarGoogle Scholar |
[18] Raifman JRG, Flynn C, German D. Healthcare provider contact and pre-exposure prophylaxis in Baltimore men who have sex with men. Am J Prev Med 2017; 52 55–63.
| Healthcare provider contact and pre-exposure prophylaxis in Baltimore men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[19] Sharma M, Wilton J, Senn H, Fowler S, Tan DHS. Preparing for PrEP: perceptions and readiness of Canadian physicians for the implementation of HIV pre-exposure prophylaxis. PLoS One 2014; 9 e105283
| Preparing for PrEP: perceptions and readiness of Canadian physicians for the implementation of HIV pre-exposure prophylaxis.Crossref | GoogleScholarGoogle Scholar |
[20] Tang EC, Sobieszczyk ME, Shu E, Gonzales P, Sanchez J, Lama JR. Provider attitudes toward oral preexposure prophylaxis for HIV prevention among high-risk men who have sex with men in Lima, Peru. AIDS Res Hum Retroviruses 2014; 30 416–24.
| Provider attitudes toward oral preexposure prophylaxis for HIV prevention among high-risk men who have sex with men in Lima, Peru.Crossref | GoogleScholarGoogle Scholar |
[21] Smith DK, Mendoza MCB, Stryker JE, Rose CE. PrEP awareness and attitudes in a national survey of primary care clinicians in the United States, 2009–2015. PLoS One 2016; 11 e0156592
| PrEP awareness and attitudes in a national survey of primary care clinicians in the United States, 2009–2015.Crossref | GoogleScholarGoogle Scholar |
[22] Desai M, Gafos M, Dolling D, Mccormack S, Nardone A. Healthcare providers’ knowledge of, attitudes to and practice of pre-exposure prophylaxis for HIV infection. HIV Med 2016; 17 133–42.
| Healthcare providers’ knowledge of, attitudes to and practice of pre-exposure prophylaxis for HIV infection.Crossref | GoogleScholarGoogle Scholar |
