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RESEARCH ARTICLE (Open Access)
Contents Vol 21(6)

Prescribing pre-exposure prophylaxis for HIV prevention: a cross-sectional survey of general practitioners in Australia

Jason Wu https://orcid.org/0009-0002-6175-5784 A B * , Christopher K. Fairley https://orcid.org/0000-0001-9081-1664 B C , Daniel Grace https://orcid.org/0000-0002-9032-3959 D , Benjamin R. Bavinton https://orcid.org/0000-0001-5834-8278 E , Doug Fraser E , Curtis Chan https://orcid.org/0000-0002-9581-1011 E , Eric P. F. Chow https://orcid.org/0000-0003-1766-0657 B C F § and Jason J. Ong https://orcid.org/0000-0001-5784-7403 B C F G §
+ Author Affiliations
- Author Affiliations

A Kings Park Medical Centre - Hillside, General Practice, Melbourne, Vic, Australia.

B Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

C School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

D University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada.

E Kirby Institute, The University of New South Wales, Kensington, NSW, Australia.

F Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.

G Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

* Correspondence to: jasun_quo@hotmail.com

§ Co-senior authors

Handling Editor: Jami Leichliter

Sexual Health 21, SH24018 https://doi.org/10.1071/SH24018
Submitted: 1 April 2024  Accepted: 16 October 2024  Published: 12 November 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Pre-exposure prophylaxis (PrEP) is a safe and effective medication for preventing HIV acquisition. We examined Australian general practitioners’ (GP) knowledge of PrEP efficacy, characteristics associated with ever prescribing PrEP and barriers to prescribing.

Methods

We conducted an online cross-sectional survey of GPs working in Australia between April and October 2022. We performed univariable and multivariable logistic regression analyses to identify factors associated with: (1) the belief that PrEP was at least 80% efficacious; and (2) ever prescribed PrEP. We asked participants to rate the extent to which barriers affected their prescribing of PrEP.

Results

A total of 407 participants with a median age of 38 years (interquartile range 33–44) were included in the study. Half of the participants (50%, 205/407) identified how to correctly take PrEP, 63% (258/407) had ever prescribed PrEP and 45% (184/407) felt confident with prescribing PrEP. Ever prescribing PrEP was associated with younger age (AOR 0.97, 95% CI: 0.94–0.99), extra training in sexual health (AOR 2.57, 95% CI: 1.54–4.29) and being a S100 Prescriber (OR 2.95, 95% CI: 1.47–5.90). The main barriers to prescribing PrEP included: ‘Difficulty identifying clients who require PrEP/relying on clients to ask for PrEP’ (76%, 310/407), ‘Lack of knowledge about PrEP’ (70%, 286/407) and ‘Lack of time’ (69%, 281/407).

Conclusion

Less than half of our GP respondents were confident in prescribing PrEP, and most had difficulty identifying who would require PrEP. Specific training on PrEP, which focuses on PrEP knowledge, identifying suitable clients and making it time efficient, is recommended, with GPs being remunerated for their time.

Keywords: Australasia, barriers, general practice, health promotion, HIV/AIDS, PrEP, prevention, primary care.

References

1  US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States – 2017 update a clinical practice guideline. US Public Health Service; 2017.

2  Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med 2012; 4(151): 151ra25.
| Crossref | Google Scholar |

3  UNAIDS. Ending inequalities and getting on track to end AIDS by 2030; 2021. Available at https://www.unaids.org/sites/default/files/media_asset/2021-political-declaration_summary-10-targets_en.pdf#:~:text=Ensure%20availability%20of%20PrEP%20for%20%2810%20million%29%20people,appropriate%2C%20prioritized%2C%20people-centred%20and%20effective%20combination%20prevention%20options

4  Department of Health and Aged Care. General Practice Workforce (2017–2018 to 2022–2023 Financial Years). Department of Health and Aged Care; 2024.

5  ASHM. ASHM Prescriber Map 2024. Available at https://www.ashm.org.au/prescriber-maps/

6  Department of Health, Australian Government. Sexual health Medicine - 2016 factsheet 2016. Available at https://hwd.health.gov.au/resources/publications/factsheet-mdcl-sexual-health-2016.pdf

7  Fraser DMN, McManus H, Guy R, Grulich AE, Bavinton BR. Monitoring HIV pre-exposure prophylaxis (PrEP) uptake in Australia (Issue 8). Sydney: Kirby Institute, UNSW Sydney; 2023.

8  Smith AKJ, Haire B, Newman CE, Holt M. Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians. Sex Health 2021; 18(2): 187-94.
| Crossref | Google Scholar | PubMed |

9  Vanhamel J, Reyniers T, Wouters E, van Olmen J, Vanbaelen T, Nöstlinger C, et al. How do family physicians perceive their role in providing pre-exposure prophylaxis for HIV prevention?–an online qualitative study in Flanders, Belgium. Front Med 2022; 9: 828695.
| Crossref | Google Scholar |

10  Villeneuve F, Cabot JM, Eymard-Duvernay S, Visier L, Tribout V, Perollaz C, et al. Evaluating family physicians’ willingness to prescribe PrEP. Med Mal Infect 2020; 50(7): 606-10.
| Crossref | Google Scholar | PubMed |

11  Rai B, Ross S, Richardson D. P051 General practitioners’(GPs’) knowledge of and attitudes to prescribing pre-exposure prophylaxis for HIV (PrEP): A pilot study. Sex Transm Infect 2021; 97: A74.

12  Chiarabini T, Lacombe K, Valin N. HIV pre-exposure chemoprophylaxis “PrEP” in general practice: are there significant barriers? [Prophylaxie préexposition au VIH (PrEP) en médecine générale: existe-t-il des freins?]. Sante Publique 2021; 33(1): 101-112.
| Crossref | Google Scholar |

13  Lane W, Heal C, Banks J. HIV pre-exposure prophylaxis: knowledge and attitudes among general practitioners. Aust J Gen Pract 2019; 48(10): 722-27.
| Crossref | Google Scholar | PubMed |

14  Lazarou M, Fitzgerald L, Warner M, Downing S, Williams OD, Gilks CF, et al. Australian interdisciplinary healthcare providers’ perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study. Sex Health 2020; 17(6): 485-92.
| Crossref | Google Scholar | PubMed |

15  Médicins du Monde. The KAP survey model (knowledge, attitudes, and practices); 2011. Available at https://www.spring-nutrition.org/publications/tool-summaries/kap-survey-model-knowledge-attitudes-and-practices

16  Wu J, Fairley CK, Grace D, Chow EPF, Ong JJ. Agreement of and discussion with clients about undetectable equals untransmissible among general practitioners in Australia: a cross-sectional survey. Sex Health 2023; 20(3):242–49. 10.1071/SH23051

17  ASHM. 2021 National PrEP guidelines; 2021. Available at https://prepguidelines.com.au

18  King J, McManus H, Kwon A, Gray R, McGregor S. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2022. Sydney: UNSW Sydney; 2022.

19  Payne H. The new RACGP gender and sex standards, explained. 2021. Available at https://www.medicalrepublic.com.au/the-new-racgp-gender-and-sex-standards-explained/57824

20  Saxby K, de New SC, Petrie D. Structural stigma and sexual orientation disparities in healthcare use: evidence from Australian Census-linked-administrative data. Soc Sci Med 2020; 255: 113027.
| Crossref | Google Scholar | PubMed |

21  Sobecki JN, Curlin FA, Rasinski KA, Lindau ST. What we don’t talk about when we don’t talk about sex: results of a national survey of U.S. obstetrician/gynecologists. J Sex Med 2012; 9(5): 1285-94.
| Crossref | Google Scholar | PubMed |

22  Holden L, Williams ID, Patterson E, Smith JW, Scuffham PA, Cheung L, et al. Uptake of Medicare chronic disease management incentives – a study into service providers’ perspectives. Aust Fam Physician 2012; 41(12): 973-7.
| Google Scholar | PubMed |

23  Ahmed K, Hashim S, Khankhara M, et al. What drives general practitioners in the UK to improve the quality of care? A systematic literature review. BMJ Open Qual 2021; 10(1): e001127.
| Crossref | Google Scholar |