Factors Influencing Clinicians' Willingness to Prescribe Pre-exposure Prophylaxis for Persons at High Risk of HIV in China: Cross-sectional Online Survey Study
Factors Influencing Clinicians' Willingness to Prescribe Pre-exposure Prophylaxis for Persons at High Risk of HIV in China: Cross-sectional Online Survey Study
复制标题
影响临床医生对中国艾滋病毒高危人群进行暴露前预防治疗的意愿的因素：横断面在线调查研究
DOI：
10.2196/preprints.24235
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Hong Shang
中科院分区：
文献类型：
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作者：
Sitong Cui;Haibo Ding;Xiaojie Huang;Hui Wang;Weiming Tang;Sequoia I Leuba;Zehao Ye;Yongjun Jiang;Wenqing Geng;Junjie Xu;Hong Shang
背景暴露前预防（PrEP）是一种有效的艾滋病预防措施。临床医生在PrEP实施中发挥着至关重要的作用，他们的知识，态度和职业经验可能会影响他们开PrEP的意愿。然而，在没有PrEP特定指南的国家，临床医生开PrEP的态度和意愿知之甚少。OBJECTIVE.我们的目的是确定与临床医生愿意在中国处方PrEP相关的因素。方法. 2019年5月至6月，我们在微信智能手机应用程序平台上对中国六个行政区的31个省份的临床医生进行了在线横断面调查。多变量逻辑回归用于确定与处方PrEP意愿相关的因素。结果共有777名艾滋病毒临床医生完成了调查。大多数受访者听说过PrEP（563/777，72.5%），31.9%（248/777）的受访者认为PrEP对降低HIV感染风险非常有效，47.2%（367/777）的受访者认为有必要向高危人群提供PrEP。在调整临床医生的年龄，性别，种族和教育背景后，以下因素显着增加了临床医生愿意开PrEP的几率：工作超过10年，相比之下，5年或更少（调整后比值比[aOR] 2.82，95% CI 1.96-4.05）;每月治疗100多名艾滋病毒感染者，而不是50名或更少（aOR 4.16，95% CI 2.85-6.08）;以及听说过PrEP（aOR 7.32，95% CI 4.88-10.97）。如果临床医生担心PrEP依从性差（aOR 0.66，95% CI 0.50-0.88），缺乏PrEP临床指南（aOR 0.47，95% CI 0.32-0.70）以及缺乏PrEP的药物适应症（aOR 0.49，95% CI 0.32 -0.76），则不太可能愿意开PrEP。结论.约一半的受访临床医生愿意开PrEP，但大多数受访者对PrEP的了解程度较低。缺乏PrEP临床指南、缺乏药物适应症以及工作经验不足11年是受访临床医生开PrEP意愿的主要障碍。制定PrEP临床指南和药物适应症，以及增加PrEP培训的可用性，可以帮助提高临床医生对PrEP的理解，从而增加愿意开PrEP的人数。
BACKGROUND. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention measure. Clinicians play a crucial role in PrEP implementation, and their knowledge, attitudes, and career experience may affect their willingness to prescribe PrEP. However, little is known about the attitudes and willingness of clinicians to prescribe PrEP in countries without PrEP-specific guidelines.. OBJECTIVE. We aimed to determine the factors associated with clinicians being willing to prescribe PrEP in China.. METHODS. Between May and June 2019, we conducted an online cross-sectional survey of clinicians in 31 provinces across the six administrative regions in China on the WeChat smartphone app platform. Multivariable logistic regression was used to determine factors associated with willingness to prescribe PrEP.. RESULTS. Overall, 777 HIV clinicians completed the survey. Most of the respondents had heard of PrEP (563/777, 72.5%), 31.9% (248/777) thought that PrEP was extremely effective for reducing the risk of HIV infection, and 47.2% (367/777) thought that it was necessary to provide PrEP to high-risk groups. After adjusting for age, gender, ethnicity, and educational background of the clinicians, the following factors significantly increased the odds of the clinicians being willing to prescribe PrEP: having worked for more than 10 years, compared to 5 years or less (adjusted odds ratio [aOR] 2.82, 95% CI 1.96-4.05); having treated more than 100 patients living with HIV per month, compared to 50 patients or fewer (aOR 4.16, 95% CI 2.85-6.08); and having heard of PrEP (aOR 7.32, 95% CI 4.88-10.97). Clinicians were less likely to be willing to prescribe PrEP if they were concerned about poor adherence to PrEP (aOR 0.66, 95% CI 0.50-0.88), the lack of PrEP clinical guidelines (aOR 0.47, 95% CI 0.32-0.70), and the lack of drug indications for PrEP (aOR 0.49, 95% CI 0.32-0.76).. CONCLUSIONS. About half of all clinicians surveyed were willing to prescribe PrEP, but most surveyed had a low understanding of PrEP. Lack of PrEP clinical guidelines, lack of drug indications, and less than 11 years of work experience were the main barriers to the surveyed clinicians’ willingness to prescribe PrEP. Development of PrEP clinical guidelines and drug indications, as well as increasing the availability of PrEP training, could help improve understanding of PrEP among clinicians and, thus, increase the number willing to prescribe PrEP..