Knowledge, attitudes, and beliefs about HIV pre-exposure prophylaxis among US Air Force Health Care Providers

Hakre, Shilpa; Blaylock, Jason M; Dawson, Peter; Beckett, Charmagne; Garges, Eric; Michael, Nelson L.; Danaher, Patrick; Scott, Paul T.; Okulicz, Jason F.

doi:10.1097/md.0000000000004511

Cited by 40 publications

(49 citation statements)

References 20 publications

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“…Class two had a slightly higher probability of agreeing that cost might pose a substantial barrier (Castel et al, 2015). Both groups of providers also identified the risk for drug resistance and risk compensation as potential barriers to PrEP use-findings that were consistent with the results of other studies of potential physician providers of PrEP (Blumenthal et al, 2015;Caceres et al, 2015;Castel et al, 2016;Hakre et al, 2016;Hankins et al, 2015;Karris et al, 2014;Krakower et al, 2014;Krakower et al, 2015;Krakower and Mayer, 2016;Puro et al, 2013;Smith et al, 2016).…”

Section: Costsupporting

confidence: 80%

“…Prescribers were hesitant in prescribing PrEP because the effectiveness of the drug was considered equivocal (Blumenthal et al, 2015;Caceres et al, 2015;Castel et al, 2016;Hakre et al, 2016;Hankins et al, 2015;Karris et al, 2014;Krakower et al, 2014;Krakower et al, 2015;Krakower and Mayer, 2016;Puro et al, 2013;Smith et al, 2016). PCPs reported lack of knowledge or training about PrEP as the main barrier in prescribing PrEP and in providing PrEP education to patients (Hakre et al, 2016).…”

Section: Safety/effectivenessmentioning

confidence: 99%

“…PCPs reported lack of knowledge or training about PrEP as the main barrier in prescribing PrEP and in providing PrEP education to patients (Hakre et al, 2016).…”

Section: Safety/effectivenessmentioning

confidence: 99%

“…Several studies focused on cost-effectiveness, investigating whether the benefits of preventing HIV through administering PrEP outweigh the costs of PrEP (Hankins et al, 2015;Hakre et al, 2016;Karris et al, 2014). Funding PrEP while other potentially more cost-effective HIV prevention interventions remain underfunded may have high opportunity costs, diverting resources from early initiation of anti-retroviral therapy or other prevention strategies (Hankins, Macklin, and Warren, 2015).…”

Section: Costmentioning

confidence: 99%

“…PCPs and infectious disease physicians in the US Air Force (USAF) participated in a cross-sectional survey examining knowledge, attitudes, and beliefs toward HIV and PrEP (Hakre et al, 2016). Barriers to PrEP utilization included concerns about costs, viral resistance, patient adherence, and side effects of medication.…”

Section: Costmentioning

confidence: 99%

See 4 more Smart Citations

Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

Grippo

Smallwood

Pincura

et al. 2017

JGPHA

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Background:In the United States, human immunodeficiency virus (HIV) remains a substantial public health issue. There is evidence that the use of antiretroviral medications such as pre-exposure prophylaxis (PrEP) can be a safe and effective primary prevention strategy to reduce new cases of HIV infection. Provider practice behavior as it relates to prescribing PrEP and the potential impact on specific vulnerable populations needs increased attention. Few studies have evaluated the attitudes of physicians towards ethical issues related to prescribing PrEP. Methods:The purpose of the present literature review was to evaluate provider attitudes toward the ethics of prescribing PrEP for individuals at risk of acquiring HIV infection. Searches of the PubMed and Cochrane databases were conducted. Three reviewers independently assessed the relevance of articles and discarded those not directly related to the attitudes of physicians toward ethics of the cost, safety, and resource allocation of PrEP. A total of twenty-one articles were included in the review.Results: Provider attitudes and perceptions focused on three areas: resource allocation, cost, and safety or effectiveness of PrEP. Providers who were hesitant in prescribing PrEP were concerned with the availability of resources, patient adherence, risk of drug resistance, and toxicity. In the studies reviewed, few providers had prescribed PrEP; however, prescribing practices trended upward with time and awareness. Conclusions:Realization of the benefits of PrEP will require a utilitarian ethical approach to identifying the populations that will benefit most, monitoring for adverse effects, addressing costs, and educating and training providers to prescribe PrEP responsibly. Ensuring that PrEP fulfills its potential as part of a combination regimen for HIV prevention requires identification of additional evidence, education, support services, and resources that are needed, as well as the regulatory framework and cost scenarios for access to PrEP.

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Section: Costsupporting

confidence: 80%

Section: Safety/effectivenessmentioning

confidence: 99%

“…PCPs reported lack of knowledge or training about PrEP as the main barrier in prescribing PrEP and in providing PrEP education to patients (Hakre et al, 2016).…”

Section: Safety/effectivenessmentioning

confidence: 99%

Section: Costmentioning

confidence: 99%

Section: Costmentioning

confidence: 99%

See 3 more Smart Citations

Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

Grippo

Smallwood

Pincura

et al. 2017

JGPHA

View full text Add to dashboard Cite

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Prevention paradox: Medical students are less inclined to prescribe HIV pre‐exposure prophylaxis for patients in highest need

et al. 2018

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IntroductionDespite healthcare providers’ growing awareness of pre‐exposure prophylaxis (PrEP), prescription rates remain low. PrEP is an efficacious HIV prevention strategy recommended for use with condoms but still protective in their absence. Concern about the impact of PrEP on condom use and other risk behaviour is, nonetheless, among the barriers to prescription commonly reported. To understand the implications of this concern for PrEP access, we examined how medical students’ willingness to prescribe PrEP varied by patients’ condom use and partnering practices. We also assessed the perceived acceptability of various reasons for condom discontinuation with PrEP.MethodsAn online survey was distributed to 854 medical students in the Northeastern US in 2015. Participants (n = 111) were surveyed about their willingness to prescribe PrEP for each of six male patients who systematically differed in their reported condom use (sustained use, sustained nonuse, or discontinuation with PrEP) and partnering practices (single male partner with untreated HIV or multiple male partners of unknown HIV status). Participants also reported perceived acceptability of four reasons for condom discontinuation: pleasure, sexual functioning, intimacy, and conception.ResultsWillingness to prescribe PrEP was inconsistent with patient risk: When the patient used condoms and planned to sustain condom use, most participants were willing to prescribe PrEP – 93% if the patient had a single partner and 86% if the patient had multiple partners. Fewer were willing to prescribe if the patient did not use condoms and planned to sustain nonuse (53% and 45%, respectively) or used condoms but planned to discontinue use (27% and 28%). Significantly fewer participants were willing to prescribe for a patient with multiple partners versus a single partner when the patient reported sustained condom use or sustained condom nonuse. The number of participants who were willing to prescribe was similarly low for a patient with multiple partners versus a single partner when the patient reported that he planned to discontinue condom use. More participants accepted a patient discontinuing condoms for conception (69%) than for intimacy (23%), pleasure (14%), or sexual functioning (13%).ConclusionMedical students’ clinical judgments were misaligned with patient risk and suggest misconceptions or personal values may undermine provision of optimal HIV prevention services.

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A Closer Look at Racism and Heterosexism in Medical Students’ Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education

et al. 2017

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Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.

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Knowledge, attitudes, and beliefs about HIV pre-exposure prophylaxis among US Air Force Health Care Providers

Abstract: Supplemental Digital Content is available in the text

Cited by 40 publications

References 20 publications

Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

Prevention paradox: Medical students are less inclined to prescribe HIV pre‐exposure prophylaxis for patients in highest need

A Closer Look at Racism and Heterosexism in Medical Students’ Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education

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