Moore Emily, Kelly Sean G, Alexander Leah, Luther Patrick, Cooper Robert, Rebeiro Peter F, Zuckerman Autumn D, Hargreaves Margaret, Bourgi Kassem, Schlundt David, Bonnet Kemberlee, Pettit April C
Vanderbilt University School of Medicine, Nashville, TN, USA.
Vanderbilt University Medical Center, Nashville, TN, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720984416. doi: 10.1177/2150132720984416.
INTRODUCTION/OBJECTIVES: Pre-exposure prophylaxis (PrEP) use in the southern United States is low despite its effectiveness in preventing HIV acquisition and high regional HIV prevalence. Our objectives were to assess PrEP knowledge, attitudes, and prescribing practices among Tennessee primary care providers. METHODS: We developed an anonymous cross-sectional electronic survey from March to November 2019. Survey development was guided by the Capability, Opportunity, Motivation, and Behavior framework and refined through piloting and interviews. Participants included members of professional society and health center listservs licensed to practice in Tennessee. Respondents were excluded if they did not complete the question regarding PrEP prescription in the previous year or were not in a position to prescribe PrEP (e.g., hospital medicine). Metrics included PrEP prescription in the preceding year, PrEP knowledge scores (range 0-8), provider attitudes about PrEP, and provider and practice characteristics. Knowledge scores and categorical variables were compared across PrEP prescriber status with Wilcoxon rank-sum and Fisher's exact tests, respectively. RESULTS: Of 147 survey responses, 99 were included and 43 (43%) reported PrEP prescription in the preceding year. Compared with non-prescribers: prescribers had higher median PrEP knowledge scores (7.3 vs 5.6, < .01), a higher proportion had self-reported patient PrEP inquiries (95% vs 21%, < .01), and a higher proportion had self-reported good or excellent ability to take a sexual history (83% vs 58%, = .01) and comfort taking a sexual history (92% vs 63%, < .01) from men who have sex with men, a subgroup with high HIV risk. Most respondents felt obligated to provide PrEP (65%), and felt all primary care providers should provide PrEP (63%). CONCLUSION: PrEP provision is significantly associated with PrEP knowledge, patient PrEP inquiries, and provider sexual history taking ability and comfort. Future research should evaluate temporal relationships between these associations and PrEP prescription as potential routes to increase PrEP provision.
引言/目标：尽管暴露前预防（PrEP）在预防艾滋病毒感染方面有效且美国南部地区艾滋病毒感染率较高，但美国南部地区PrEP的使用率较低。我们的目标是评估田纳西州初级保健提供者对PrEP的知识、态度和处方行为。 方法：我们在2019年3月至11月开展了一项匿名横断面电子调查。调查的开展以能力、机会、动机和行为框架为指导，并通过试点和访谈进行完善。参与者包括田纳西州专业协会成员和有执业许可的健康中心邮件列表用户。如果受访者在前一年没有完成关于PrEP处方的问题，或者没有开具PrEP的资格（如医院内科医生），则将其排除。指标包括前一年的PrEP处方情况、PrEP知识得分（范围为0 - 8）、提供者对PrEP的态度以及提供者和执业机构的特征。PrEP处方者状态不同，知识得分和分类变量分别采用Wilcoxon秩和检验和Fisher精确检验进行比较。 结果：在147份调查回复中，99份被纳入分析，43份（43%）报告在前一年开具过PrEP处方。与未开具处方者相比：开具处方者的PrEP知识得分中位数更高（7.3对5.6，<0.01），自我报告有患者询问PrEP的比例更高（95%对21%，<0.01），自我报告有良好或优秀的获取男男性行为者性病史能力的比例更高（83%对58%，=0.01），且从男男性行为者（艾滋病毒高风险亚组）获取性病史时更自在的比例更高（92%对63%，<0.01）。大多数受访者认为有义务提供PrEP（65%），并认为所有初级保健提供者都应提供PrEP（63%）。 结论：PrEP的提供与PrEP知识、患者对PrEP的询问、提供者获取性病史的能力及自在程度显著相关。未来研究应评估这些关联与PrEP处方之间的时间关系，将其作为增加PrEP提供的潜在途径。
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