Bunting Samuel R, Feinstein Brian A, Vidyasagar Nitin, Wilson Allison, Schneider John, Ehsan Dustin A, Hazra Aniruddha
Department of Psychiatry and Behavioral Neuroscience The University of Chicago Medicine Chicago Illinois USA.
Department of Psychology College of Health Professions Rosalind Franklin University North Chicago Illinois USA.
Psychiatr Res Clin Pract. 2024 Sep 18;6(4):151-163. doi: 10.1176/appi.prcp.20240069. eCollection 2024 Winter.
People living with mental illness (PLWMI) experience a disproportionate prevalence and incidence of HIV. Preventing HIV among PLWMI is a priority for multiple domestic public health agencies. As key clinicians for this group, psychiatrists may have an important role to play in increasing PrEP use among PLWMI.
A national survey of psychiatrists ( = 880) about integrating PrEP prescription into psychiatric practice was conducted between November 2022-October 2023. Specifically, we inquired about experiences with PrEP prescription, patient request for PrEP, and interest in prescribing PrEP. We also inquired about barriers to PrEP prescription in psychiatry and preferred models for implementing PrEP prescription in psychiatry.
We found that 19.3% of psychiatrists had received a request for PrEP from a patient, 17.3% had prescribed, and 53.9% were interested in prescribing. The greatest percentage of psychiatrists who prescribed PrEP were practicing primarily in inpatient psychiatry (28.8%). Practicing in one of the federal (EHE) priority jurisdictions (aOR = 2.08 [1.23-3.54], = 0.003) and greater self-confidence in PrEP-related tasks (aOR = 2.10 [1.67-2.65], < 0.001) were associated with higher likelihood of PrEP prescription. Limited knowledge of PrEP was the barrier endorsed by the greatest percentage of psychiatrists (76.3%). Most preferred a hypothetical model in which a psychiatrist prescribed an initial course of PrEP with prompt primary care or infectious disease follow-up (63.1%).
Most psychiatrists were interested in prescribing PrEP. Training is needed to enable PrEP implementation in psychiatric practice including development of collaborative practice models to engage psychiatrists across a diversity of settings.
精神疾病患者（PLWMI）感染艾滋病毒的患病率和发病率不成比例。在PLWMI中预防艾滋病毒是多个国内公共卫生机构的优先事项。作为该群体的关键临床医生，精神科医生在增加PLWMI中暴露前预防（PrEP）的使用方面可能发挥重要作用。
在2022年11月至2023年10月期间对880名精神科医生进行了一项关于将PrEP处方纳入精神科实践的全国性调查。具体而言，我们询问了PrEP处方经验、患者对PrEP的需求以及开具PrEP的意愿。我们还询问了精神科中PrEP处方的障碍以及精神科实施PrEP处方的首选模式。
我们发现，19.3%的精神科医生收到过患者对PrEP的需求，17.3%的医生开具过PrEP，53.9%的医生有开具PrEP的意愿。开具PrEP的精神科医生中，最大比例的主要从事住院精神科工作（28.8%）。在联邦指定的重点辖区之一执业（调整后比值比[aOR]=2.08[1.23 - 3.54]，P = 0.003）以及对PrEP相关任务更有自信（aOR = 2.10[1.67 - 2.65]，P < 0.001）与开具PrEP的可能性更高相关。PrEP知识有限是大多数精神科医生认可的障碍（76.3%）。大多数人倾向于一种假设模式，即精神科医生开具PrEP初始疗程，并由初级保健或传染病专科医生及时跟进（63.1%）。
大多数精神科医生有开具PrEP的意愿。需要进行培训，以在精神科实践中实施PrEP，包括开发协作实践模式，让不同环境下的精神科医生参与其中。
