493. Evolution of Massachusetts Physician Attitudes, Knowledge and Experience Regarding the Use of Antiretrovirals for HIV Prevention
Session: Poster Abstract Session: HIV Testing and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: The CAPRISA and iPrEx studies demonstrated that topical or oral chemoprophylaxis could decrease HIV transmission, yet to have an appreciable public health impact, physicians and other health care worker will need to be educated about these   new developments in HIV prevention.
Methods: Massachusetts-based generalists and HIV specialists were recruited via email to complete an online survey of their knowledge and use of HIV prevention interventions. Data were collected before (July-December, 2010) (n=178) and after (December, 2010-April, 2011) (n=112) the release of iPrEx data.
Results: Most of the respondents were specialists (60%), with a mean age of 42. Although 46% (primarily specialists) had prescribed post-exposure prophylaxis, only 5% had prescribed pre-exposure prophylaxis (PrEP). Over the two time intervals, knowledge of oral PrEP significantly increased (79% to 92%, p< 0.01), whereas knowledge about topical microbicides was already high (89%). Post-iPrEx, specialists tended to be more knowledgeable about oral PrEP (p<0.01) and topical microbicides (p<0.001) than generalists. The majority of the specialists (58%) and 42% of generalists felt that oral PrEP should be available to all persons at risk for HIV, while 39% of generalists and 61% of specialists felt that topical gel should be available. Only 3% felt PrEP should never be used. Ongoing concerns included: potential side effects (88%), drug resistance (85%) and limited amount of data regarding PrEP’s clinical efficacy (80%). The majority (69%) preferred a gel to oral PrEP because they perceived fewer side effects/less selection for resistance (95%), increased ease of use (55%) and a cheaper cost (52%). Those who preferred oral PrEP thought it would be easier to use (81%). Participants indicated that  formal CDC guidelines would have the greatest impact on PrEP provision (92%).
Conclusion: Among Massachusetts physicians sampled, chemoprophylaxis knowledge was high, but current experience was limited. Although, topical gel was preferred, responses suggested a willingness to adapt practices as further guidance from normative bodies becomes available. Educational programs aimed at incorporating chemoprophylaxis into physicians' HIV prevention practices are warranted.

Subject Category: H. HIV/AIDS and other retroviruses

Kenneth Mayer, MD, Medicine, Beth Israel Hospital/Harvard Medical School , Boston , MA; Fenway Community Health, Providence, RI, Jaclyn White, MPH, The Fenway Institute, Fenway Health, Boston , MA, Douglas Krakower, MD, Medicine, Beth Israel Hospital/Harvard Medical School , Boston, MA and Matthew Mimiaga, MPH, ScD, Psychiatry, Fenway Health/Massachusetts General Hospital/Harvard School of Public Health, Boston, MA


K. Mayer, Gilead Sciences: Grant Investigator, Grant recipient

J. White, None

D. Krakower, None

M. Mimiaga, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.