The Acceptability of Pre-Exposure Prophylaxis: Beliefs of Health-Care Professionals Working in Sexually Transmitted Infections Clinics and HIV Treatment Centers

Abstract

BackgroundPre-exposure prophylaxis (PrEP) is highly effective for preventing HIV infections, but is not yet implemented in the Netherlands. As the attitudes of health-care professionals toward PrEP can influence future PrEP implementation, we studied PrEP knowledge and beliefs and their association with PrEP acceptability among professionals in clinics for sexually transmitted infection (STI professionals) and HIV treatment centers (HIV specialists). In addition, we examined preferred regimens, attitudes toward providing PrEP to key populations and to reimbursement of PrEP costs.MethodsAn online questionnaire was distributed among 24 public health STI clinics and 27 HIV treatment centers nationwide in the Netherlands between January and August 2015. The acceptability of PrEP was measured on a 7-point Likert scale ranging from 1 = low to 7 = high acceptability. Univariable and multivariable linear regression analyses were used to explore associations between demographic characteristics, PrEP knowledge, beliefs about PrEP, and PrEP acceptability.ResultsIn total, 209 people (143 STI professionals and 66 HIV specialists) completed the questionnaire. The mean acceptability of PrEP implementation was 4.28 (SD 1.68) among STI professionals and 4.42 (SD 1.67) among HIV specialists. The mean score on self-perceived knowledge related to PrEP efficacy was 3.90 (SD 1.57) among STI professionals and 5.68 (SD 1.08) among HIV specialists (p-value of <0.001). Beliefs associated with lower PrEP acceptability among both groups were the fear that PrEP use will lead to a decrease in condom use and an increase in STI, the high costs of PrEP and ethical issues regarding prescribing antiretroviral medication to healthy individuals. No preference for a daily or an event-driven regimen was detected. Most participants deemed the following groups to be eligible for PrEP: men who have sex with men (MSM) who regularly get post-exposure prophylaxis, MSM who never used condoms with casual partners and MSM with an HIV-positive partner with a detectable viral load. Over half of the participants indicated that PrEP users should partly (54.1%) or fully (35.4%) pay the costs of PrEP.ConclusionIn 2015, PrEP acceptability was only moderate among Dutch STI professionals and HIV specialists, which is far from an optimal setting. Addressing barriers to PrEP acceptability in educational programs for various types of health-care professionals is needed to successfully implement PrEP in the Netherlands.

HIV Pre-Exposure Prophylaxis (PrEP) Counseling in Germany: Knowledge, Attitudes and Practice in Non-governmental and in Public HIV and STI Testing and Counseling Centers

“…In this context, it is worth pointing out that the response rates of 42 and 57% for NG counseling centers and local health offices, respectively, were comparatively high for a survey of this nature. For example, surveys on PrEP among physicians in the USA and the Netherlands had response rates of 23.5 and 39%, respectively ( 30 , 32 ). While high response rates cannot guarantee unbiased estimates, they do provide less opportunity for selection bias to occur.…”

“…However, surveys from the US suggest that knowledge of PrEP may also be limited among physicians ( 30 , 31 ). A survey among Dutch providers of STI and HIV services showed a moderate willingness to prescribe PrEP and limited knowledge of PrEP, especially among STI specialists ( 32 ). The provision of PrEP-related training for physicians has been discussed as a factor that could improve the implementation of PrEP ( 30 , 31 ).…”

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

“…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.…”

Influence of Stigma on Pre-Exposure Prophylaxis (PrEP) Care Continuum Among Men and Transwomen Who Have Sex with Men (MTWSM) in the United States

“…Men and transwomen who have sex with men, in particular, are highly stigmatized and discriminated against due to their sexual orientation, which negatively affects health outcomes, decisions to access or utilize HIV prevention services (e.g., PrEP), and the quality of care they receive. A number of recent studies have examined factors that may affect PrEP willingness, uptake or adherence among these groups [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”