南非埃库鲁莱尼地区医护人员对口腔 HIV 暴露前预防 (PrEP) 的知识、态度和实践。

Knowledge, attitudes and practices of oral HIV pre-exposure prophylaxis (PrEP) among healthcare workers in the Ekurhuleni District, South Africa.

机构信息

School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa.

South African Field Epidemiology Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa.

出版信息

S Afr Med J. 2023 Dec 4;113(12):46. doi: 10.7196/SAMJ.2023.v113i12.1171.

DOI:10.7196/SAMJ.2023.v113i12.1171

PMID:38525627

Abstract

BACKGROUND

Prevention of new HIV infections is crucial for controlling the HIV epidemic. Despite HIV pre-exposure prophylaxis (PrEP) being one of the highly effective approaches to preventing HIV, and being freely available through primary healthcare clinics (PHCs), the uptake of HIV PrEP in South Africa (SA) is low.

OBJECTIVE

To understand knowledge, attitudes and practices (KAPs) of healthcare workers responsible for generating demand for HIV PrEP services, or identifying clients eligible for HIV PrEP services in PHCs in Ekurhuleni District, South Africa.

METHODS

We conducted a cross-sectional interviewer-administered survey among healthcare workers from 45 randomly selected PHCs in Ekurhuleni District. We collected information on participant characteristics and their KAPs regarding HIV PrEP service delivery. KAP scores were developed using a priori cut-off points and participants were categorised into binary levels of KAPs. We performed descriptive and multivariable logistic regression analysis in line with the study objectives.

RESULTS

We enrolled 160 study participants from 1 May to 30 June 2022. About two-thirds of the participants (64.4%) were highly knowledgeable about HIV PrEP, and 58.1% self-reported practices that were considered to be good. Notably, 73.1% of participants had negative attitudes toward HIV PrEP delivery. Participants who were aged >50 years had poor HIV PrEP knowledge (adjusted odds ratio (aOR) 0.1; 95% confidence interval (CI) 0.0 - 0.4; p=0.01) compared with participants <30 years old. Participants aged 30 - 40 years had poor HIV knowledge although their association is not statistically significant. Nurses had higher HIV PrEP knowledge (aOR 11.1; 95% CI 3.8 - 32.4, p<0.001) compared with health promoters. Both nurses (aOR=0.2, 95% CI 0.1 - 0.6; p<0.001) and HIV testing service counsellors (aOR 0.3; 95% CI 0.1 - 0.9; p=0.02) had negative attitudes toward HIV PrEP, compared with health promoters. Nurses had better practices in HIV PrEP delivery compared with health promoters (aOR 2.5; 95% CI 1.0 - 5.9; p=0.04).

CONCLUSION

Among the healthcare workers tasked with generating demand and identifying clients eligible for HIV PrEP services, low knowledge of HIV PrEP and negative attitudes towards HIV PrEP may be barriers to the uptake of HIV PrEP. Training healthcare workers on HIV PrEP is recommended.

摘要

背景

预防新的 HIV 感染对于控制 HIV 疫情至关重要。尽管 HIV 暴露前预防（PrEP）是预防 HIV 的一种非常有效的方法，并且可以通过初级保健诊所（PHC）免费获得，但南非（SA）的 HIV PrEP 使用率很低。

目的

了解负责生成 HIV PrEP 服务需求或在南非埃库鲁莱尼地区的 PHC 中确定有资格接受 HIV PrEP 服务的客户的医疗保健工作者的知识、态度和实践（KAP）。

方法

我们在 2022 年 5 月 1 日至 6 月 30 日期间，对埃库鲁莱尼地区 45 个随机选择的 PHC 的医疗保健工作者进行了横断面访谈式调查。我们收集了参与者特征以及他们关于 HIV PrEP 服务提供的知识、态度和实践信息。使用事先确定的截止点制定 KAP 评分，参与者被分类为 KAP 的二元水平。我们根据研究目标进行了描述性和多变量逻辑回归分析。

结果

我们于 2022 年 5 月 1 日至 6 月 30 日期间从 160 名研究参与者中招募。大约三分之二的参与者（64.4%）对 HIV PrEP 有很高的了解，58.1%的人报告的做法被认为是好的。值得注意的是，73.1%的参与者对 HIV PrEP 服务的提供持消极态度。与年龄<30 岁的参与者相比，年龄>50 岁的参与者 HIV PrEP 知识较差（调整后的优势比（aOR）0.1；95%置信区间（CI）0.0-0.4；p=0.01）。年龄在 30-40 岁的参与者尽管他们的关联没有统计学意义，但 HIV 知识较差。护士的 HIV PrEP 知识较高（aOR 11.1；95%CI 3.8-32.4，p<0.001），与健康促进者相比。与健康促进者相比，护士（aOR=0.2，95%CI 0.1-0.6；p<0.001）和 HIV 检测服务顾问（aOR 0.3；95%CI 0.1-0.9；p=0.02）对 HIV PrEP 持消极态度。与健康促进者相比，护士在 HIV PrEP 服务提供方面的实践更好（aOR 2.5；95%CI 1.0-5.9；p=0.04）。