Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States of America.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States of America.
PLoS One. 2020 Sep 3;15(9):e0238375. doi: 10.1371/journal.pone.0238375. eCollection 2020.
Less than 10 percent of the more than one million people vulnerable to HIV are using pre-exposure prophylaxis (PrEP). Practitioners are critical to ensuring the delivery of PrEP across care settings. In this study, we target a group of prescribers focused on providing HIV care and seeking up-to-date information about HIV. We assessed their experiences prescribing PrEP, whether these experiences differed by clinical specialty, and examined associations between willingness to prescribe PrEP as a "best first step" and different hypothetical prescribing scenarios.
Between March and May 2015, we circulated a paper survey to 954 participants ((652 of whom met our inclusion criteria of being independent prescribers and 519 of those (80%) responded to the survey)) at continuing medical education advanced-level HIV courses in five locations across the US on practitioner practices and preferences of PrEP. We employed multivariable logistic regression analysis for binary and collapsed ordinal outcomes.
Among this highly motivated group of practitioners, only 54% reported ever prescribing PrEP. Internal medicine practitioners were 1.6 times more likely than infectious disease practitioners to have prescribed PrEP (95% CI: 0.99-2.60, p = .0524) and age, years of training, and sex were significantly associated with prescribing experience. Based on clinical vignettes describing different hypothetical prescribing scenarios, practitioners who viewed PrEP as the first clinical step for persons who inject drugs (PWID) were twice as likely to have also considered PrEP as the first clinical option for safer conception, and vice-a-versa (95% CI: 1.4-3.2, p < .001). Practitioners considering PrEP as the first preventive option for MSM were nearly six times as likely to also consider PrEP as the first clinical step for PWID, and vice-a-versa (95% CI: 2.28-13.56, p = .0002).
Our findings indicate that even among a subset of HIV-focused practitioners, PrEP prescribing is not routine. This group of practitioners could be an optimal group to engage individuals that could most benefit from PrEP.
在超过 100 万易感染艾滋病毒的人群中，只有不到 10%的人在使用暴露前预防（PrEP）。从业者对于确保在各种医疗环境中提供 PrEP 至关重要。在这项研究中，我们将目标锁定在一组专注于提供艾滋病毒护理并寻求有关艾滋病毒最新信息的开处方者。我们评估了他们开 PrEP 处方的经验，以及这些经验是否因临床专业而异，并探讨了愿意将 PrEP 作为“最佳第一步”开处方与不同假设的开处方方案之间的关联。
2015 年 3 月至 5 月期间，我们在美国五个地点的继续医学教育高级 HIV 课程上向 954 名参与者（其中 652 名符合我们独立处方者的纳入标准，其中 519 名（80%）对调查做出了回应）分发了一份纸质调查问卷，调查了从业者对 PrEP 的实践和偏好。我们对二项和合并有序结果采用多变量逻辑回归分析。
在这群积极性很高的从业者中，只有 54%的人报告曾开过 PrEP 处方。与传染病医生相比，内科医生开 PrEP 的可能性高 1.6 倍（95%CI：0.99-2.60，p =.0524），年龄、培训年限和性别与开处方经验显著相关。根据描述不同假设的开处方情况的临床病例，将 PrEP 视为注射吸毒者（PWID）的首要临床步骤的从业者，考虑将 PrEP 作为更安全受孕的首要临床选择的可能性也增加了一倍（95%CI：1.4-3.2，p <.001）。将 PrEP 视为男男性行为者（MSM）的首要预防选择的从业者，考虑将 PrEP 作为 PWID 的首要临床步骤的可能性也增加了近六倍，反之亦然（95%CI：2.28-13.56，p =.0002）。
我们的研究结果表明，即使在一组专注于 HIV 的从业者中，PrEP 的处方也并非常规。这群从业者可能是最适合让那些最能从 PrEP 中受益的人参与进来的理想群体。
