Smith Dawn K, Mendoza Maria C B, Stryker Jo Ellen, Rose Charles E
Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
PLoS One. 2016 Jun 3;11(6):e0156592. doi: 10.1371/journal.pone.0156592. eCollection 2016.
As trials were assessing the safety and efficacy of daily oral antiretroviral preexposure prophylaxis (PrEP) for the prevention of HIV infection, there was a clear need to understand the evolution of knowledge of, and attitudes toward, PrEP among primary care clinicians.
Physicians and nurse practitioners were surveyed in 2009 (n = 1500), 2010 (n = 1504), 2012 (n = 1503), 2013 (n = 1507), 2014 (n = 1508) and 2015 (n = 1501) to assess their awareness of PrEP, willingness to prescribe PrEP, and whether they support use of public funds to pay for PrEP. Pharmacists (n = 251) were surveyed about PrEP in 2012 only. Descriptive statistics were computed for physician demographics and PrEP-related questions. Prevalence ratios for willingness to prescribe PrEP were computed using Poisson regression analysis.
Awareness of PrEP was low among clinicians (2009: 24%, 2010: 29%) but increased after trials reported effectiveness (2012: 49%, 2013: 51%, 2014: 61%, 2015: 66%). Following a description of PrEP with an estimated effectiveness of 75%, across 6 of the study years 91% of clinicians indicated a willingness to prescribe PrEP to at least one group at high risk of HIV acquisition. A smaller majority of clinicians indicated support for public funding of PrEP in 2009: 59%, 2010: 53%, and 2013: 63%.
In surveys conducted before and after the release of PrEP trial results, primary care clinicians were largely unaware of PrEP. They indicated high levels of willingness to prescribe it for patients at high risk of HIV acquisition and expressed interest in education about how to deliver this new clinical HIV prevention method. It will be important to continue monitoring clinician knowledge, attitudes, and practices as the use of PrEP increases in the US.
由于各项试验正在评估每日口服抗逆转录病毒药物暴露前预防（PrEP）预防HIV感染的安全性和有效性，因此迫切需要了解基层医疗临床医生对PrEP的认识演变及态度。
在2009年（n = 1500）、2010年（n = 1504）、2012年（n = 1503）、2013年（n = 1507）、2014年（n = 1508）和2015年（n = 1501）对医生和执业护士进行调查，以评估他们对PrEP的知晓情况、开具PrEP处方的意愿以及是否支持使用公共资金支付PrEP费用。仅在2012年对药剂师（n = 251）进行了关于PrEP的调查。计算医生人口统计学特征和与PrEP相关问题的描述性统计数据。使用泊松回归分析计算开具PrEP处方意愿的患病率比值。
临床医生对PrEP的知晓率较低（2009年：24%，2010年：29%），但在试验报告有效性后有所提高（2012年：49%，2013年：51%，2014年：61%，2015年：66%）。在描述PrEP估计有效性为75%之后，在6个研究年份中，91%的临床医生表示愿意为至少一组HIV感染高危人群开具PrEP处方。在2009年、2010年和2013年，支持公共资金用于PrEP的临床医生占比略少：分别为59%、53%和63%。
在PrEP试验结果公布前后进行的调查中，基层医疗临床医生大多不了解PrEP。他们表示非常愿意为HIV感染高危患者开具PrEP处方，并对有关如何提供这种新的临床HIV预防方法的教育表现出兴趣。随着美国PrEP使用的增加，持续监测临床医生的知识、态度和实践将很重要。
