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

Abstract

IntroductionHIV 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.MethodsWe 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.ResultsEighty-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.ConclusionsGuatemalan 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.

Perceptions of HIV transmission and pre-exposure prophylaxis among health care workers and community members in Rwanda

“…Health care workers (86.6%) showed similar interest in PrEP as their counterparts from neighboring East-African countries [ 18 ], while members of the community from our study were more interested in PrEP compared to data reported from some other African countries (93.5% vs 61% respectively[ 20 ]. This variability probably reflects differences in community engagement in and education around HIV prevention tools and strategies.…”

Awareness and willingness to use HIV pre‐exposure prophylaxis among men who have sex with men in low‐ and middle‐income countries: a systematic review and meta‐analysis

“…Key structural factors included perceived staff attitudes, a lack of quality assurance, a lack of data protection and confidentiality, and cost [31,32,37,40,50,52]. Apart from addressing stigma and general competency to provide MSM with PrEP among healthcare providers in LMICwhich have been noted by others [83,84] our results suggest that strengthening health systems so as to assure universal provision of high-quality PrEP, while protecting the identities of MSM, will be critical. Strengthening drug regulation in middle-income countries has also been highlighted as essential by other authors [85].…”

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“…Almost all data related to provider willingness to prescribe PrEP include concerns about risk compensation, that is, the possibility that PrEP users will increase their risk behavior after going on PrEP, undermining the potential benefit. In surveys of provider attitudes toward PrEP prescription across countries, risk compensation concerns remain paramount, 39,40 and are associated with both prescribing and referring patients for PrEP in primary care. 41 Data on the existence of risk compensation effects are equivocal.…”