Background: Non-occupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP) are newer antiretroviral (ARV) based HIV prevention tools that may currently be underutilized. We sought to evaluate providers experience with, knowledge of, and attitudes towards nPEP and PrEP prior to institutional roll out of both initiatives.
Methods: A survey was disseminated in March 2015 to a convenience sample of providers in infectious disease, HIV medicine, emergency medicine, and family medicine. P-values were calculated using χ2 test.
Results: Among 48 respondents, 52% were female and the majority of providers (77%) were Caucasian. Most (73%) reported interacting with at least 20 people living with HIV over the prior three months; 52% reported less than five years experience providing HIV care. PEP and PrEP had been prescribed by 77% and 44% of respondents respectively. Requests for both were rare (51% any PEP, 30% PrEP) or never (40% any PEP, 56% PrEP). Many knew guidelines are available (64% PEP, 67% PrEP), and roughly half (52% and 56%) stated familiarity with the recommendations. However, on multiple-choice questions only 38% identified one first-line or alternate PEP regimen and one contraindicated PEP regimen correctly. Similarly, 39% and 52% identified the approved PrEP regimens for heterosexuals and men having sex with men, respectively. Almost all (96%) knew that the PEP regimen of tenofovir, emtricitabine, and raltegravir has minimal drug-drug interactions, and that receptive anal intercourse is higher risk for HIV transmission than occupational needle stick (89%). Sexual assault and single sexual encounters with unknown partner stood out as risk factors that most affected prescription of nPEP versus PrEP (p<0.05); there was less of a distinction between the two for other factors (Figure 1). Beliefs about potential unintended consequences of PrEP and nPEP use were mixed but did not vary between the two prevention methods (Figure 2).
Conclusion: Prescribers had varying levels of experience with nPEP and PrEP, and deficits were noted in knowledge of some aspects of the guidelines. In many areas, there was no clear distinction between beliefs about and prescription of nPEP and PrEP, suggesting that further education may be warranted.
J. Mignano, None
J. Weaver, None
P. Ryscavage, None