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Knowledge is Power! Increased Provider Knowledge Scores Regarding Pre-exposure Prophylaxis (PrEP) are Associated with Higher Rates of PrEP Prescription and Future Intent to Prescribe PrEP

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Abstract

The FDA approval of emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis (PrEP) in 2012 has raised questions about the delivery of PrEP in a real-world setting. iPad-based questionnaires were given to providers at conferences in California and New York to assess knowledge, experience and attitudes regarding PrEP in HIV and non-HIV providers. HIV provider status was defined either by self-identification or by having greater than 5 years of HIV care experience. Knowledge scores were the sum of correct answers from five PrEP knowledge questions. Univariate analyses used t-test to compare knowledge scores and Fisher’s exact test for past or future PrEP prescription between HIV and non-HIV providers. Multivariable linear or logistic regression models were used to assess factors associated with the outcomes. Of 233 respondents, the mean age was 40 years, 59 % were White, 59 % were physicians and 52 % were HIV providers. In univariate analysis, mean PrEP knowledge scores (max 5) were significantly higher for HIV providers (2.8 versus 2.2; p < 0.001), age > 41 (mean 2.8 versus 2.3; p = 0.004), White race (2.7 versus 2.2; p = 0.026) and participants in the New York region (3.0 versus 2.3; p < 0.001). In a multivariable model of knowledge scores, all but age remained significant. Among 201 potential prescribers, the rate of prior PrEP prescription was higher among HIV providers than non-HIV providers (34 versus 9 %; p < 0.001) and by knowledge score, but the association with provider status was no longer significant in multivariable analysis that controlled for knowledge. Intent to prescribe PrEP in the future was high for all provider types (64 %) and was associated with knowledge scores in multivariable analysis. The most common concerns about PrEP (>40 % of providers) were drug toxicities, development of resistance and patient adherence to follow-up; 32 % identified risk compensation as a concern. HIV providers had significantly greater PrEP knowledge than non-HIV providers, but differences by provider type in past PrEP prescription were largely dependent on knowledge. Future PrEP prescription was also associated with knowledge, though all providers expressed greater future use. Education of potential PrEP providers will be a key component of successful PrEP implementation.

Resumen

La aprobación de Emtricitabina/Fumarato de Disoproxilo de Tenofovir por la FDA para PrEP en 2012 ha originado preguntas acerca del suministro de profilaxis pre-exposición (PrEP) en un escenario real. Cuestionarios a través de dispositivo iPad fueron proporcionados a proveedores de salud especialistas en VIH y proveedores de salud en general durante conferencias en California y Nueva York para evaluar conocimiento, experiencia y actitudes en cuanto a PrEP. La categoría de proveedor de salud especialista en VIH fue definida por identificación propia o por tener más de cinco años de experiencia en el cuidado de VIH. Los marcadores de conocimiento fueron la suma de respuestas correctas a cinco preguntas de conocimiento sobre PrEP. El análisis univariado utilizó la prueba t-test para comparar los marcadores de conocimiento y la prueba exacta Fisher se utilizó para pasadas o futuras prescripciones médicas de PrEP entre proveedores de salud especialistas en VIH y proveedores de salud en general. Los modelos linear multivariable o de regresión logística fueron utilizados para evaluar factores asociados con los resultados. De 233 encuestados, la edad promedio fue 40 años, 59 % fueron raza Blanca, 59 % fueron médicos y 52 % fueron proveedores de salud especialistas en VIH. En análisis univariado, el promedio en el marcador de de conocimientos sobre PrEP (max 5) fue significativamente mayor para proveedores de salud especialistas en VIH (en un 2.8 versus 2.2; p<0.001), edad >41 (promedio 2.8 versus 2.3; p=0.004), raza blanca (2.7 versus 2.2; p=0.0.26) y los participantes de la region de Nueva York (3.0 versus 2.3; p<0.001). En el modelo multivariable de marcadores de conocimiento, todo excepto la edad permaneció significantivo. Entre 201 potenciales proveedores que prescribirán una receta médica para PrEP, el índice de haber prescrito con aterioridad fue mayor entre proveedores de salud especialistas en VIH que en los proveedores de salud en general (34 % versus 9 %; p<0.001) en cuanto a marcador de conocimiento, la asociacion de la categoría de los proveedores de salud no fue significantiva en el anáslisis multivariable que controló el conocimiento. Los planes de prescribir PrEP en un futuro fue mayor para los dos tipos de proveedores de salud (64 %) y estuvo asociada con los marcadores de conocmiento en el análisis multivariable. Las preocupaciones más communes en cuanto a PrEP (>40 % de los proveedores) fue la toxicidad del medicamento, desarrollo de Resistencia y la adherencia o apego de parte del paciente; 32 % identificaron a la compensación de riesgo como una preocupación. Proveedores de salud especialistas en VIH tuvieron un conocimiento de PrEP significativamente mayor que los proveedores de salud en general, pero las diferencias entre los tipos de proveedor en prescripciones médicas de PrEP anteriores fueron ampliamente dependientes del conocimiento. Prescripciones médicas de PrEP futuras fue asociado con conocimiento, sin embargo todos los proveedores expresaron una mayor utilización en el futuro. La educación sobre PrEP en proveedores de salud será un componente clave en el éxito de la implementación de PrEP.

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Acknowledgments

The work was supported by award EI11-SD-005 from CHRP; by the UCSD Center for AIDS Research – Bioinformatics and Information Technology Core; and by NIAID grants AI064086 (K24 to RH), AI27670 (UCSD ACTU) AI36214 (UCSD CFAR), K23 MH098795 (to DK) and 5T32AI007036. Dr. Blumenthal is supported by Grant T32 AI007036. Dr. Krakower is supported by Grant K23 MH098795. Dr. Haubrich is supported by award from CHRP and NIAID Grants K24 AI064086, ACTU AI27670 and CFAR AI36214.

Conflict of interest

There are no relevant conflict of interests.

Disclosure

Jill Blumenthal has no financial disclosures. Sonia Jain has no financial disclosures. Douglas Krakower reports research support from Gilead Sciences and Bristol Myers Squibb. Xiaoying Sun has no financial disclosures. Jason Young has no financial disclosures. Kenneth Mayer reports research support from Gilead Sciences and Alere. Richard Haubrich reports having received honoraria or consultant fees from Bristol Myers Squibb, Gilead Sciences, Janssen and Merck and research support (to UCSD) from Abbott, GlaxoSmithKline, Pfizer and Merck.

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Authors and Affiliations

  1. Division of Infectious Diseases, University of California, San Diego, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA

    Jill Blumenthal, Jason Young & Richard Haubrich

  2. Division of Biostatistics and Bioinformatics, University of California, San Diego, San Diego, CA, USA

    Sonia Jain & Xiaoying Sun

  3. Division of Infectious Diseases, Beth Israel Deaconness, Boston, MA, USA

    Douglas Krakower & Kenneth Mayer

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Blumenthal, J., Jain, S., Krakower, D. et al. Knowledge is Power! Increased Provider Knowledge Scores Regarding Pre-exposure Prophylaxis (PrEP) are Associated with Higher Rates of PrEP Prescription and Future Intent to Prescribe PrEP. AIDS Behav 19, 802–810 (2015). https://doi.org/10.1007/s10461-015-0996-z

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