Understanding HIV Care Provider Attitudes Regarding Intentions to Prescribe PrEP

Castel, Amanda D.; Feaster, Daniel J.; Tang, Wenze; Willis, Sarah J.; Jordan, Heather; Villamizar, Kira; Kharfen, Michael; Kolber, Michael A.; Rodríguez, Allan; Metsch, Lisa R.

doi:10.1097/qai.0000000000000780

Cited by 67 publications

(67 citation statements)

References 30 publications

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“…Latent class analysis was conducted to divide the providers into two groups: class one, who were identified as perceiving PrEP as less effective with substantial barriers; and class two, who perceived PrEP as being moderately effective with few barriers. 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%

“…Although general knowledge about and support for PrEP have increased since the FDA approved Truvada and the CDC released the prescribing guidelines, knowledge of PrEP among providers has increased only slightly, and prescribing rates remain relatively low (Castel et al, 2015). The willingness of physicians to prescribe PrEP has significant implications for PrEP access; however, few studies have evaluated the attitudes of physicians towards the ethics of the cost, safety, and resource allocation of prescribing PrEP.…”

Section: Prep and Ethical Decision-makingmentioning

confidence: 99%

“…As stated in this report, 53% of the providers were concerned about the cost of the drug and reimbursement procedures (Castel et al, 2015). Latent class analysis was conducted to divide the providers into two groups: class one, who were identified as perceiving PrEP as less effective with substantial barriers; and class two, who perceived PrEP as being moderately effective with few barriers.…”

Section: Costmentioning

confidence: 99%

“…Even though prescribers were aware of PrEP and its use, many were reluctant to prescribe it (Castel et al, 2015;Hakre et al, 2016Krakower et al, 2015Karris et al, 2015;Krakower and Mayer, 2012;Mayer, 2016, Puro et al, 2013;Smith et al, 2016). For example, a survey of 184 clinicians working for a New England AIDS Educational and Resource Center was conducted to investigate prescribing practices (Krakower et al, 2015).…”

Section: Prescriber Practicesmentioning

confidence: 99%

“…A study by Castel et al (2015) examined PrEP knowledge, experience, and likelihood of prescribing PrEP among HIV providers in Miami, FL, and Washington, DC. As stated in this report, 53% of the providers were concerned about the cost of the drug and reimbursement procedures (Castel et al, 2015).…”

Section: Costmentioning

confidence: 99%

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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: Prep and Ethical Decision-makingmentioning

confidence: 99%

Section: Costmentioning

confidence: 99%

Section: Prescriber Practicesmentioning

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

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Using a HIV prevention cascade for identifying missed opportunities in PrEP delivery in Kenya: results from a programmatic surveillance study

Were¹,

Musau²,

Mutegi³

et al. 2020

J Intern AIDS Soc

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IntroductionHIV prevention cascades have been systematically evaluated in high‐income countries, but steps in the pre‐exposure prophylaxis (PrEP) service delivery cascade have not been systematically quantified in sub‐Saharan Africa. We analysed missed opportunities in the PrEP cascade in a large‐scale project serving female sex workers (FSW), men who have sex with men (MSM) and adolescent girls and young women (AGYW) in Kenya.MethodsProgrammatic surveillance was conducted using routine programme data from 89 project‐supported sites from February 2017 to December 2019, and complemented by qualitative data. Healthcare providers used nationally approved tools to document service statistics. The analyses examined proportions of people moving onto the next step in the PrEP continuum, and identified missed opportunities. Missed opportunities were defined as implementation gaps exemplified by the proportion of individuals who could have potentially accessed each step of the PrEP cascade and did not. We also assessed trends in the cascade indicators at monthly intervals. Qualitative data were collected through 28 focus group discussions with 241 FSW, MSM, AGYW and healthcare providers, and analysed thematically to identify reasons underpinning the missed opportunities.ResultsDuring the study period, 299,798 individuals tested HIV negative (211,927 FSW, 47,533 MSM and 40,338 AGYW). Missed opportunities in screening for PrEP eligibility was 58% for FSW, 45% for MSM and 78% for AGYW. Of those screened, 28% FSW, 25% MSM and 65% AGYW were ineligible. Missed opportunities for PrEP initiation were lower among AGYW (8%) compared to FSW (72%) and MSM (75%). Continuation rates were low across all populations at Month‐1 (ranging from 29% to 32%) and Month‐3 (6% to 8%). Improvements in average annual Month‐1 (from 26% to 41%) and Month‐3 (from 4% to 15%) continuation rates were observed between 2017 and 2019. While initiation rates were better among younger FSW, MSM and AGYW (<30 years), the reverse was true for continuation.ConclusionsThe application of a PrEP cascade framework facilitated this large‐scale oral PrEP programme to conduct granular programmatic analysis, detecting “leaks” in the cascade. These informed programme adjustments to mitigate identified gaps resulting in improvement of selected programmatic outcomes. PrEP programmes are encouraged to introduce the cascade analysis framework into new and existing programming to optimize HIV prevention outcomes.

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Prevalence of pretreatment HIV drug resistance in key populations: a systematic review and meta‐analysis

Macdonald

Mbuagbaw

Jordan

et al. 2020

J. Intern. AIDS Soc.

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Introduction WHO’s 2019 report on HIV drug resistance (HIVDR) documents a high prevalence of pretreatment drug resistance (PDR) among populations initiating first‐line antiretroviral therapy (ART) in low‐ and middle‐income countries (LMIC). However, systematic evidence on the prevalence of PDR among key populations remains limited. We performed a systematic review to characterize levels of PDR in key population groups and compared them to levels of PDR in the “general population” across different geographical regions. Methods Ten electronic databases were searched for papers published until February 2019 that included predefined search terms. We included studies that reported the number of successfully tested genotypes and the number of genotypes with drug resistance mutations among antiretroviral therapy treatment naïve people, recently infected people, or people initiating first‐line ART from key populations. To assess the prevalence of PDR for each key population, we pooled estimates using random‐effects meta‐analysis of proportions. Where possible, we computed the differences in the odds of PDR (any, and by drug class) present in each key population compared to the “general population”. The I2 statistic (a measure of heterogeneity between studies) is reported. Results and discussion A total of 332 datasets (from 218 studies) and 63,111 people with successful HIVDR genotyping were included in the analysis. The pooled prevalence estimate of any PDR was high among men who have sex with men (13.0%, 95% CI 11.0 to 14.0%, I2 = 93.19), sex workers (17.0%, 95% CI 6.0 – 32.0, I2 = 87.31%) and people in prisons (18.0%, 95% CI 11.0 to 25.0, I2 = 70.18%), but less so among people who inject drugs (7.0%, 95% CI 5.0 to 10.0, I2 = 90.23). Overall, men who have sex with men were more likely to carry any PDR compared to the “general population,” a finding which was statistically significant (odds ratio (OR) 1.28, 95% CI 1.13 – 1.46, I2 48.9%). Conclusions High prevalence of PDR found in key populations highlights the need to increase access to effective first‐line HIV treatment. The low prevalence of nucleotide reverse transcriptase inhibitor (NRTI) PDR suggests that current WHO recommendations for pre‐exposure prophylaxis (PrEP) regimens will remain effective and can be scaled up to prevent new HIV infections in high‐risk groups.

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Understanding HIV Care Provider Attitudes Regarding Intentions to Prescribe PrEP

Cited by 67 publications

References 30 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

Using a HIV prevention cascade for identifying missed opportunities in PrEP delivery in Kenya: results from a programmatic surveillance study

Prevalence of pretreatment HIV drug resistance in key populations: a systematic review and meta‐analysis

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