Cargando…

Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation

INTRODUCTION: HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended...

Descripción completa

Detalles Bibliográficos
Autores principales: Ross, Ian, Mejia, Carlos, Melendez, Johanna, Chan, Philip A., Nunn, Amy C., Powderly, William, Goodenberger, Katherine, Liu, Jingxia, Mayer, Kenneth H., Patel, Rupa R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336255/
https://www.ncbi.nlm.nih.gov/pubmed/28257475
http://dx.doi.org/10.1371/journal.pone.0173057
_version_ 1782512184853528576
author Ross, Ian
Mejia, Carlos
Melendez, Johanna
Chan, Philip A.
Nunn, Amy C.
Powderly, William
Goodenberger, Katherine
Liu, Jingxia
Mayer, Kenneth H.
Patel, Rupa R.
author_facet Ross, Ian
Mejia, Carlos
Melendez, Johanna
Chan, Philip A.
Nunn, Amy C.
Powderly, William
Goodenberger, Katherine
Liu, Jingxia
Mayer, Kenneth H.
Patel, Rupa R.
author_sort Ross, Ian
collection PubMed
description INTRODUCTION: HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. METHODS: We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. RESULTS: Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. CONCLUSIONS: Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala.
format Online
Article
Text
id pubmed-5336255
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-53362552017-03-10 Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation Ross, Ian Mejia, Carlos Melendez, Johanna Chan, Philip A. Nunn, Amy C. Powderly, William Goodenberger, Katherine Liu, Jingxia Mayer, Kenneth H. Patel, Rupa R. PLoS One Research Article INTRODUCTION: HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. METHODS: We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. RESULTS: Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. CONCLUSIONS: Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala. Public Library of Science 2017-03-03 /pmc/articles/PMC5336255/ /pubmed/28257475 http://dx.doi.org/10.1371/journal.pone.0173057 Text en © 2017 Ross et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Ross, Ian
Mejia, Carlos
Melendez, Johanna
Chan, Philip A.
Nunn, Amy C.
Powderly, William
Goodenberger, Katherine
Liu, Jingxia
Mayer, Kenneth H.
Patel, Rupa R.
Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation
title Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation
title_full Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation
title_fullStr Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation
title_full_unstemmed Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation
title_short Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation
title_sort awareness and attitudes of pre-exposure prophylaxis for hiv prevention among physicians in guatemala: implications for country-wide implementation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336255/
https://www.ncbi.nlm.nih.gov/pubmed/28257475
http://dx.doi.org/10.1371/journal.pone.0173057
work_keys_str_mv AT rossian awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT mejiacarlos awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT melendezjohanna awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT chanphilipa awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT nunnamyc awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT powderlywilliam awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT goodenbergerkatherine awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT liujingxia awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT mayerkennethh awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation
AT patelrupar awarenessandattitudesofpreexposureprophylaxisforhivpreventionamongphysiciansinguatemalaimplicationsforcountrywideimplementation