Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US
Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US
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DOI：
10.1371/journal.pone.0238375
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发表时间：
2020-09-03
期刊：
影响因子：
3.7
通讯作者：
Drainoni, Mari-Lynn
中科院分区：
文献类型：
--
作者：
Leech, Ashley A.;Christiansen, Cindy L.;Drainoni, Mari-Lynn
背景和目的在100多万易感染艾滋病毒的人群中，只有不到10%的人在使用暴露前预防（PrEP）。从业人员对于确保在整个护理环境中提供PrEP至关重要。在这项研究中，我们的目标是一组专注于提供艾滋病毒护理和寻求有关艾滋病毒的最新信息的处方医生。我们评估了他们的经验处方PrEP，这些经验是否因临床专业而异，并检查了将PrEP处方作为“最佳第一步”的意愿与不同假设处方情景之间的关联。背景和方法2015年3月至5月，我们向954名参与者分发了一份问卷调查，（其中652人符合我们的独立处方者入选标准，其中519人（80%）对调查做出了回应），他们在继续医学教育中取得了进展-水平艾滋病毒课程在五个地点在美国的从业人员的做法和偏好的准备。我们采用多变量逻辑回归分析二元和折叠顺序结果。结果在这一高度积极性的从业者群体中，只有54%的人报告曾开过PrEP。内科医生开PrEP的可能性是传染病从业者的1.6倍（95%CI：0.99-2.60，p = 0.0524），年龄、培训年限和性别与开处方经验显著相关。根据描述不同假设处方情况的临床小插曲，将PrEP视为注射药物（PWID）人员的第一个临床步骤的从业者也有可能将PrEP视为更安全概念的第一个临床选择，反之亦然（95% CI：1.4-3.2，p < .001）。考虑PrEP作为MSM的第一预防选择的从业者几乎是考虑PrEP作为PWID的第一临床步骤的六倍，反之亦然（95% CI：2.28-13.56，p = .0002）。结论我们的研究结果表明，即使在一个子集的艾滋病毒为重点的从业者，PrEP处方是不常规的。这组从业者可能是一个最佳的群体，可以让最能从PrEP中受益的个人参与进来。
Background and objectives Less than 10 percent of the more than one million people vulnerable to HIV are using pre-exposure prophylaxis (PrEP). Practitioners are critical to ensuring the delivery of PrEP across care settings. In this study, we target a group of prescribers focused on providing HIV care and seeking up-to-date information about HIV. We assessed their experiences prescribing PrEP, whether these experiences differed by clinical specialty, and examined associations between willingness to prescribe PrEP as a "best first step" and different hypothetical prescribing scenarios. Setting and methods Between March and May 2015, we circulated a paper survey to 954 participants ((652 of whom met our inclusion criteria of being independent prescribers and 519 of those (80%) responded to the survey)) at continuing medical education advanced-level HIV courses in five locations across the US on practitioner practices and preferences of PrEP. We employed multivariable logistic regression analysis for binary and collapsed ordinal outcomes. Results Among this highly motivated group of practitioners, only 54% reported ever prescribing PrEP. Internal medicine practitioners were 1.6 times more likely than infectious disease practitioners to have prescribed PrEP (95% CI: 0.99-2.60, p = .0524) and age, years of training, and sex were significantly associated with prescribing experience. Based on clinical vignettes describing different hypothetical prescribing scenarios, practitioners who viewed PrEP as the first clinical step for persons who inject drugs (PWID) were twice as likely to have also considered PrEP as the first clinical option for safer conception, and vice-a-versa (95% CI: 1.4-3.2, p < .001). Practitioners considering PrEP as the first preventive option for MSM were nearly six times as likely to also consider PrEP as the first clinical step for PWID, and vice-a-versa (95% CI: 2.28-13.56, p = .0002). Conclusions Our findings indicate that even among a subset of HIV-focused practitioners, PrEP prescribing is not routine. This group of practitioners could be an optimal group to engage individuals that could most benefit from PrEP.