Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation

HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World...

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Bibliographic Details
Published in:PloS one 2017-03, Vol.12 (3), p.e0173057-e0173057
Main Authors: Ross, Ian, Mejia, Carlos, Melendez, Johanna, Chan, Philip A, Nunn, Amy C, Powderly, William, Goodenberger, Katherine, Liu, Jingxia, Mayer, Kenneth H, Patel, Rupa R
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Analysis
Anti-HIV Agents - therapeutic use
Antiretroviral agents
Attitude of Health Personnel
Biology and Life Sciences
Cross-Sectional Studies
Demographics
Demography
Disease prevention
Disease transmission
Drug abuse
Exposure
Female
Guatemala
Health aspects
Health Knowledge, Attitudes, Practice
Health risk assessment
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - prevention & control
Human immunodeficiency virus
Humans
Infections
Infectious diseases
Lentivirus
Logistic Models
Male
Medical personnel
Medicine
Medicine and Health Sciences
Middle Aged
Occupational health
People and Places
Physicians
Physicians - psychology
Practice Patterns, Physicians' - statistics & numerical data
Pre-Exposure Prophylaxis - statistics & numerical data
Prescription writing
Prevention
Prophylaxis
Prostitution
Regression
Retroviridae
Sex
Sexual partners
Sexually transmitted diseases
STD
Surveys and Questionnaires
Workers
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Summary:HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0173057