Awareness, knowledge, and attitudes towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among pharmacy students

Knowledge of pharmacy students regarding HIV/AIDS: A cross-sectional survey

INTRODUCTION

Pharmacy students play a crucial role in addressing the HIV epidemic; therefore, it is essential that they develop a thorough understanding of HIV/AIDS. In Brazil, knowledge about HIV/AIDS has been explored among health students, however research with pharmacy students is limited.

OBJECTIVE

To assess the knowledge of pharmacy students concerning HIV/AIDS at a large university in Brazil.

METHODS

A cross-sectional study was conducted between May and November 2023 among undergraduate Pharmacy students at a Federal University in Southeastern Brazil. The students were invited to complete the 12-item HIV/AIDS Knowledge Assessment Tool (HIV-KA) and provide demographic and educational data. The HIV-KA total score was calculated by summing all correct responses, ranging from 0 to 12, with higher scores indicating greater knowledge. A binary logistic regression analysis was conducted. The study was approved by the Ethics Committee (Protocol No. 5.995.451).

RESULTS

A total of 215 pharmacy students completed the survey. The mean HIV-KA score was 10 (SD = 1.54, range: 3-12). The proportion of students deemed as having a high level of knowledge was 43.7 % (score ≥ 11), moderate level was 25.1 % (score = 10), and low level was 31.2 % (score ≤ 9). The items related to pre-exposure prophylaxis (PrEP) and use of antiretroviral drugs during pregnancy had lower levels of correct answers. In the adjusted binary logistic regression analysis, internships and courses with HIV/AIDS-specific content were associated with higher knowledge levels among pharmacy students.

CONCLUSION

Overall, students showed moderate to high understanding of HIV/AIDS, but knowledge gaps were noted in areas like PrEP and antiretroviral use during pregnancy. Internships and HIV/AIDS-focused courses were key factors linked to higher knowledge levels.

Medical and Pharmacy Students' Awareness, Knowledge, and Attitudes Toward Injectable HIV Pre-Exposure Prophylaxis (PrEP)

Ending the HIV epidemic in the United States will require increasing the uptake of HIV biomedical prevention strategies, such as injectable pre-exposure prophylaxis (PrEP). One avenue to potentially increase injectable PrEP prescriptions is to educate the next generation of healthcare providers. The purpose of this study was to examine injectable PrEP knowledge, awareness, and willingness to perform injectable PrEP-related clinical activities among medical and pharmacy students. From November 2022-January 2023, we conducted a web-based, cross-sectional observational study among 395 medical and pharmacy students from one public university in New York State. The survey assessed injectable PrEP awareness, knowledge, familiarity with injectable PrEP prescribing guidelines, comfort performing injectable PrEP-related clinical activities, and willingness to perform injectable PrEP-related activities. Overall, participants reported low injectable PrEP awareness, knowledge, and familiarity with prescribing guidelines. Despite this, participants reported relatively high levels of comfort with performing injectable PrEP-related tasks. While there were no statistically significant differences in domains of interest, pharmacy students reported greater awareness, knowledge, familiarity with prescribing guidelines, and comfort performing injectable PrEP-related tasks. Linear regression models illustrated that pharmacy students were statistically significantly less willing to initiate a conversation about injectable PrEP with eligible patients compared to medical students. Future healthcare providers will play a pivotal role in implementing new biomedical prevention strategies for HIV, including injectable PrEP. Results illustrate the need for additional educational programs to increase injectable PrEP knowledge among health professional students.

Innovation in Providing Equitable Pre-exposure Prophylaxis Services in the United States: Expanding Access in Nontraditional Settings

BACKGROUND

Pre-exposure prophylaxis (PrEP) usage has slowly increased in the United States, but significant disparities persist across race, ethnicity, sex, gender, age, and geography. Determinants of PrEP inequities include stigma and medical mistrust, lack of patient-centered services, lack of access to clinical care, and organizational resistance to change-within a health care system that neglects these barriers.

METHODS

We describe 5 implementation strategies to providing PrEP in nontraditional settings to underserved populations, using an equity-based approach to address key structural determinants. The alternative settings used in these Ending the HIV Epidemic projects (community-based organizations, telePrEP, mobile clinics, pharmacies, emergency departments) were chosen for the setting characteristics and their serving structurally underserved populations.

RESULTS

Community-based organizations have earned trust within communities and can serve as hubs for comprehensive sexual health services, including PrEP. Telehealth, which expanded significantly because of COVID-19, can help overcome transportation and scheduling barriers to PrEP access. Mobile clinics can also broaden PrEP delivery by bringing tailored services directly to communities, often providing shorter wait times and extended hours. Pharmacists can prescribe PrEP in certain states through legislation or collaborative practice agreements, offering a convenient, community-based option. Emergency departments provide an alternative site for PrEP delivery, with the potential to reach individuals not currently engaged in regular care.

CONCLUSION

These alternative PrEP approaches can expand options for accessing PrEP and alleviate key barriers to care in traditional settings, although they may not eliminate all inequities. Offering more choices increases the likelihood that a broader population will be reached, thereby enhancing overall access to PrEP.

Assessment Tools for Evaluating Pharmacy Students' Knowledge on HIV Prophylaxis: A Scoping Review

OBJECTIVES

This study aimed to identify and evaluate instruments used to measure pharmacy students' knowledge of HIV prophylaxis, focusing on both preexposure prophylaxis (PrEP) and postexposure prophylaxis.

METHODS

A systematic literature search was conducted using PubMed, Virtual Health Library, Web of Science, Scopus, ScienceDirect, and Embase. Article screening was performed independently by 2 reviewers. Studies assessing pharmacy students' knowledge of HIV prophylaxis were included.

FINDINGS

Eight studies involving 1,797 students, mostly from the U.S., were identified. All had a cross-sectional design, with only one assessing knowledge retention. Six assessment tools focused on PrEP, one on PEP, and one on both. While confidence in PrEP was evident, significant gaps were found in PEP awareness, prophylaxis access, and prescribing guidelines.

SUMMARY

There is a notable shortage of assessment tools for PEP. Further research is needed to develop validated instruments for measuring knowledge and addressing educational gaps. Longitudinal studies with pre- and post-tests are crucial to evaluate educational interventions and enhance pharmacy students' preparedness for HIV prophylaxis.

Bon Sante (Good Health): Factors Influencing PrEP Use Among Haitians/Haitian Americans

BACKGROUND

The HIV/AIDS epidemic has disproportionately affected Black individuals in the USA, and this health disparity has increased over time. Despite the effectiveness of pre-exposure prophylaxis (PrEP) as a prevention tool for HIV, there are disparities in its use, and uptake of this intervention remains low among racial and ethnic minorities, including Haitians/Haitian Americans. In this study, factors influencing PrEP use among Haitians/Haitian Americans in Miami, FL, are explored to provide necessary data to address disparities.

METHODS

The research team collaborated with local organizations to recruit 30 individuals (Haitians/Haitian Americans) between February 4 and October 1, 2021, and conducted semi-structured interviews. All interviews were audio-recorded and transcribed, and NVivo® was used to analyze the transcripts for emergent themes.

RESULTS

The study sample comprised 30 adults of Haitian descent in Miami, FL (50% female, approximately 67% with a high school education or more, mean age = 43.7 ± 13 years, and 74.2% born in Haiti). Four primary themes emerged from the analysis: (1) limited PrEP awareness, (2) underutilization of PrEP, (3) inadequate discussion of HIV prevention strategies, and (4) PrEP delivery encompassing barriers and facilitators for PrEP delivery and promotion strategies.

CONCLUSION

This study indicated that there is a critical need to increase Haitians/Haitian Americans' knowledge regarding PrEP. Health communication interventions tailored specifically for Haitians/Haitian Americans that target stigma, attitudes toward HIV, and risk perception may be significant in increasing PrEP in this population.

Assessing pharmacy students' HIV pre-exposure prophylaxis (PrEP) prescribing knowledge, PrEP attitudes, and HIV-related stigma

Introduction

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) significantly reduces the risk of acquiring HIV. To increase PrEP prescribing, it is crucial to evaluate the preparedness of future pharmacists who will play a pivotal role in providing PrEP education, counseling, and prescribing.

Objective

We assessed PrEP-prescribing knowledge, attitudes, and HIV-related stigma of pharmacy students.

Methods

We conducted a cross-sectional web-based survey of student pharmacists in their final two years of education and training at the three University of California pharmacy schools. Survey questions assessed students' awareness of PrEP, familiarity with prescribing guidelines and Senate Bill 159 (SB159), PrEP knowledge, HIV-related stigma, and attitudes about PrEP. The sample was characterized using descriptive statistics, and non-parametric tests were used to examine associations between dependent variables and independent variables. A p-value <0.05 was deemed statistically significant.

Results

A total of 110 students participated in the survey. The greatest familiarity with guidelines was observed in male (77.4%) (p = 0.047) and gay-identifying (100%) (p = 0.039) students compared with other genders and sexual identities, respectively. Non-advanced pharmacy practice experience (APPE) students (70.3%) displayed significantly more familiarity with SB159 than APPE students (65.2%) (p = 0.006). Non-APPE students displayed higher HIV-related stigma compared with APPE students (13.8 vs. 9.4, p = 0.0015). Significant differences in PrEP knowledge (p = 0.0105), HIV-related stigma (p = 0.0003), and PrEP attitudes (p = 0.0098) were observed between the schools. African American students had a significantly higher mean PrEP attitudes score (mean = 51.0, standard deviation [SD] = 3.6) compared with other racial categories (p = 0.0329).

Conclusion

Elevated HIV-related stigma, in the presence of high levels of PrEP knowledge, highlights the need to focus on destigmatizing HIV prevention services and increasing anti-stigma training, which is imperative in preparing student pharmacists to prescribe PrEP.

A Mixed Methods Evaluation of Pharmacists' Readiness to Provide Long-Acting Injectable HIV Pre-exposure Prophylaxis in California

BACKGROUND

Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP.

METHODS

In 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP.

RESULTS

Half of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services.

CONCLUSION

Pharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.

HIV pre-exposure prophylaxis champion preceptorship training for pharmacists and nurses in the United States

Introduction

Relatively little has been published on human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) training efforts and outcomes among clinicians working at community health centers and safety net clinical settings.

Objectives

This study describes the National Clinician Consultation Center's (NCCC's) PrEP training content development and learning outcomes.

Methods

The training consisted of a multidisciplinary capacity-building program designed to increase PrEP-related clinical knowledge and skills among pharmacy and nursing professionals at community health centers in "Ending the HIV Epidemic" priority jurisdictions. Descriptive statistics were used to report on the results of this training.

Results

Two groups of learners completed the hybrid training program in 2022 (total, N = 50). A comparison of pretraining and posttraining evaluations indicated that, collectively, learners' self-rated knowledge increased across all assessment domains including PrEP eligibility, disparities, laboratory monitoring, medication options and pharmacotherapy decision-making, and delivery of person-centered care. Learners rated the experience favorably, particularly for large group case discussion sessions. Among the 15 learners who completed the 6-month follow-up survey, many indicated an increase in PrEP services as well as additional training of colleagues and clinic staff.

Conclusion

The NCCC's uniquely developed PrEP capacity-building program is a highly acceptable and valuable training program that can help increase PrEP-related clinical knowledge and skills among pharmacy and nursing professionals at community health centers across the United States.

Facilitators and barriers to community pharmacy PrEP delivery: a scoping review

INTRODUCTION

Pre-exposure prophylaxis (PrEP) is an effective medication to reduce the risk of acquiring HIV. PrEP is available free of charge in the UK from sexual health clinics. Expanding PrEP delivery to community pharmacies holds promise and aligns with UK government goals to eliminate new cases of HIV by 2030. The aim of this scoping review was to describe the existing evidence about the barriers to and facilitators of community pharmacy oral PrEP delivery, for pharmacists and pharmacy clients, as aligned with the Capacity Opportunity, Motivation Behaviour (COM-B) Model.

METHODS

Five bibliographic and five review databases were searched from inception to August 2023. Literature of any study design was included if it discussed barriers and facilitators of community pharmacy PrEP delivery. Trial registrations, protocols and news articles were excluded.

RESULTS

A total of 649 records were identified, 73 full texts were reviewed and 56 met the inclusion criteria, predominantly from high-income/westernized settings. Most of the included literature was original research (55%), from the United States (77%) conducted during or after the year 2020 (63%). Barriers to PrEP delivery for pharmacists included lack of knowledge, training and skills (capability), not having the necessary facilities (opportunity), concern about the costs of PrEP and believing that PrEP use could lead to risk behaviours and sexually transmitted infections (motivation). Facilitators included staff training (capability), time, the right facilities (opportunity), believing PrEP could be a source of profit and could reduce new HIV acquisitions (motivation). For clients, barriers included a lack of PrEP awareness (capability), pharmacy facilities (opportunity) and not considering pharmacists as healthcare providers (motivation). Facilitators included awareness of PrEP and pharmacist's training to deliver it (capability), the accessibility of pharmacies (opportunity) and having an interest in PrEP (motivation).

DISCUSSION

To effectively enhance oral PrEP delivery in UK community pharmacies, the identified barriers and facilitators should be explored for UK relevance, addressed and leveraged at the pharmacy team, client and care pathway level.

CONCLUSIONS

By comprehensively considering all aspects of the COM-B framework, community pharmacies could become crucial providers in expanding PrEP accessibility, contributing significantly to HIV prevention efforts.

Design, Implementation, and Assessment Approaches Within an Advanced Human Immunodeficiency Virus (HIV) Elective Course

Introduction: An estimated 38 million people are living with human immunodeficiency virus (HIV) worldwide. Pharmacists are well positioned to provide care to patients with HIV, but gaps in HIV education among pharmacists exist. Recognizing the need to educate and prepare future pharmacists, a 2-credit advanced HIV elective course was created for Doctor of Pharmacy students at Washington State University College of Pharmacy and Pharmaceutical Sciences in the United States, and Masters of Clinical Pharmacy students from University of Western Cape School of Pharmacy in South Africa. Methods: Course topics included diagnosis and treatment of HIV in children and adults, management of common comorbidities, pre-exposure prophylaxis, pharmacogenetic applications, and antiretroviral drug-drug interactions. Course effectiveness was evaluated using student examination results. Student perceptions were evaluated using pre- and post-course self-assessments involving abilities, confidence, and attitudes toward caring for people living with HIV. Results: Student pharmacists demonstrated competency in HIV knowledge, demonstrated skills in application to clinical-based scenarios, and reported significantly improved confidence and abilities as well as positive changes in attitudes toward people with HIV. Conclusion: This course contributed to student learning across different student cohorts in an institutional program in the United States including successful execution of distance learning and clinical application for students at a program in South Africa.

Knowledge and attitudes of HIV pre-exposure prophylaxis among nurses in South Africa

BACKGROUND

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) has shown efficacy and effectiveness in populations who practise high-risk sexual activity. Nurses' knowledge and positive attitudes enhance PrEP implementation.

AIM

This study aimed to investigate the knowledge of and attitudes towards PrEP among nurses in primary health care facilities.

SETTING

The study was conducted in 10 health facilities that offer comprehensive services in Tshwane, South Africa.

METHODS

A cross-sectional survey assessed the knowledge of and attitudes towards PrEP among 114 nurses. Univariate, bivariate and logistic regressions were performed to estimate odds ratios and to determine whether age, sex and education had an association with the knowledge and attitudes.

RESULTS

Majority of the study sample consisted of female nurses (92.1%), and most respondents (68%) had moderate PrEP knowledge. Logistic regression showed that age and education were not associated with high level of knowledge. Pre-exposure prophylaxis was viewed negatively by 84.5% of the respondents. The odds of positive attitudes towards PrEP were 1.92 times higher among males than females (95% CI 0.54-6.83) and 1.24 times higher among nurses who had bachelor's degree than diploma holders (95% CI 0.51-3.01).

CONCLUSION

This study found that there is a need to strengthen the dissemination of information about PrEP, and nurses in South Africa require training to improve their knowledge of and attitudes towards PrEP.Contribution: The findings of the study add to the current knowledge base regarding PrEP access in the public healthcare system and it highlights gaps in the training of healthcare providers.

Effects of knowledge and implicit biases on pharmacy students' decision-making regarding pre-exposure prophylaxis for HIV prevention: A vignette-based experimental study

INTRODUCTION

Men who have sex with men (MSM), especially Black MSM, are disproportionately affected by HIV and experience disparate prescription of pre-exposure prophylaxis (PrEP) for HIV prevention compared to White MSM. While pharmacists are essential in efforts to scale-up PrEP, little is known about the role of knowledge and implicit biases in pharmacy students' decision-making regarding PrEP, which may elucidate mechanisms for improving PrEP access and addressing disparities.

METHODS

A nationwide, cross-sectional study of pharmacy students in the United States was conducted. A fictional White or Black MSM seeking PrEP was presented. Participants completed measures of PrEP/HIV knowledge, implicit racism and heterosexism, assumptions about the patient's behavior (condomless sex, extra-relational sex, adherence to PrEP), and confidence providing PrEP-related care.

RESULTS

A total of 194 pharmacy students completed the study. Compared to the White patient, the Black patient was assumed to be less adherent to PrEP if prescribed. In contrast, assumptions of sexual risk behaviors if prescribed PrEP and confidence providing PrEP-related care did not differ. Additionally, implicit racism was associated with lower confidence providing PrEP-related care, whereas PrEP/HIV knowledge, implicit sexual orientation bias, and assumed sexual risk behaviors if prescribed PrEP were not associated with confidence.

CONCLUSIONS

Pharmacists are essential in efforts to scale-up PrEP prescription, making pharmacy education about PrEP for HIV prevention critical. These findings suggest that implicit bias awareness training is needed. This training may reduce the influence of implicit racial bias on confidence providing PrEP-related care and improve knowledge of HIV and PrEP.

Willingness to Prescribe PrEP to Bisexual Men Depends on Genders of Their Past Partners: A Study of Medical Students in the USA

Bisexual men are at increased risk for HIV compared to heterosexual men but unlikely to use pre-exposure prophylaxis (PrEP). Given that biases may influence whether bisexual men are prescribed PrEP, we examined whether medical students' decision-making was influenced by the genders of a bisexual male patient's partners. Medical students (N = 718) were randomized to one of nine conditions where they answered questions about a bisexual male patient after reviewing his electronic medical record. We manipulated the gender of his current partner (none, male, female) and the genders of his past partners (male, female, both). Current partners were described as living with HIV and not yet virally suppressed, past partners were described as being of unknown HIV-status, and condom use was described as intermittent with all partners. When the patient was not in a current relationship, perceived HIV risk and likelihood of prescribing PrEP were lowest if he only had female partners in the past. When he was in a current relationship, perceived HIV risk and likelihood of prescribing PrEP did not differ based on current or past partners' genders. In addition, identification as a PrEP candidate, perceived likelihood of adherence, and perceived likelihood of engaging in condomless sex if prescribed were lower when the patient was not in a current relationship. Medical students appropriately prioritized the status of the partner living with HIV, but their decision-making was influenced by past partner genders when the patient was not in a current relationship. Medical students may require additional education to ensure they understand PrEP eligibility criteria and make decisions based on patients' individual presentations.

Pharmacy-Based Interventions to Increase Use of HIV Pre-exposure Prophylaxis in the United States: A Scoping Review

HIV pre-exposure prophylaxis (PrEP) remains underutilized in the U.S. Since greater than 85% of PrEP prescriptions are filled at commercial pharmacies, pharmacists are uniquely positioned to increase PrEP use. This scoping review explores pharmacy-based initiatives to increase PrEP use. We searched PubMed, PsycINFO, CINAHL, and Scopus for peer-reviewed studies on pharmacist-led interventions to increase PrEP use or pharmacy-based PrEP initiatives. Forty-nine articles were included in this review. Overall, studies demonstrated that patients expressed strong support for pharmacist prescription of PrEP. Three intervention designs compared changes in PrEP initiation or knowledge pre- and post-intervention. Commentary/review studies recommended PrEP training for pharmacists, policy changes to support pharmacist screening for HIV and PrEP prescription, and telemedicine to increase prescriptions. Pharmacists could play key roles in improving PrEP use in the U.S. Studies that assess improvements in PrEP use after interventions such as PrEP prescription, PrEP-specific training, and adherence monitoring by pharmacists are needed.

Interest In and Uptake of HIV Pre-Exposure Prophylaxis (PrEP): A Cross-Sectional Study of High-Risk Patients in Western Canada

Rationale

Pre-exposure prophylaxis (PrEP) is a highly effective, evidence-based HIV prevention strategy. However, its use in the city of Saskatoon, Saskatchewan province of western Canada, is relatively new. Therefore, this study aimed to examine the interest and uptake of PrEP and investigate factors associated with HIV PrEP by high-risk patients.

Methods 

A cross-sectional, self-administered survey of patients attending Saskatoon’s Public Health Services Sexual Health Clinic was conducted from October until December 2018. The primary outcome was the interest in taking PrEP to reduce the risk of HIV infection. This outcome was evaluated for its association with potential correlates, which included: sociodemographic characteristics, HIV risk perception, prior PrEP awareness, and sexual behaviors/lifestyles. Descriptive, univariate, and multivariate analyses were used to pursue our research objectives.

Results

One hundred forty-one participants were recruited from a sexual health clinic in Saskatoon. The median age (interquartile range) was 26 (22-31) years. The median number of partners (interquartile range) was 3 (2-4) partners. A total of 66.0% of participants were unaware of PrEP, and almost half ( 49.6%) indicated an interest in taking PrEP. Among those disinterested in PrEP, 49.3% perceived minimal HIV risk, 35.2% expressed concern regarding side effects, 28.1% cited the added need for condom use, 23.9% indicated incomplete effectiveness, and 22.5% did not wish to undergo regular bloodwork. Multivariate analysis showed that interested patients were more likely to have been previously aware of PrEP (OR: 2.6, p-value = 0.03), perceived themselves to be vulnerable to HIV (OR: 15.7, p = <0.0001), or were unsure about their risk (OR: 3.9, p = 0.001).

Conclusion

This study suggests that a lack of knowledge regarding personal HIV risk and PrEP as a preventive option may influence PrEP interest. There lies a need for more health promotion campaigns around the health benefits of PrEP, including literacy efforts on HIV risk, concerns around side effects, and associated blood work with PrEP use.

Knowledge of HIV and HIV pre-exposure prophylaxis among medical and pharmacy students: A national, multi-site, cross-sectional study

Pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing HIV. However, prescription of PrEP has not reached the scale that is necessary to meet the public health need of reducing HIV incidence. A factor contributing to this slow scale-up is limited healthcare practitioners' knowledge of PrEP, making PrEP education a priority. We conducted a national, cross-sectional study of medical (allopathic and osteopathic) and pharmacy students regarding knowledge of PrEP and HIV between October 2020 and February 2021. We included 28 items in our knowledge assessment. Analysis sought to identify gaps in knowledge as well as academic and demographic correlates of knowledge. A total of 2,353 students participated in the study (response rate = 17.0%). The overall mean HIV knowledge score was 79.6% correct. Regarding specific items, 68.7% of participants believed HIV treatment was difficult because it required many pills, and 61.1% incorrectly indicated a person with an undetectable HIV viral load could transmit the virus to their sexual partners. Overall mean PrEP knowledge was 84.1%. Approximately one-third of participants did not identify HIV-negative status as a requirement to be a PrEP candidate. Gay/lesbian participants and those who were in the late-phase of training reported higher knowledge of both HIV and PrEP than did heterosexual participants and those in the early-phase of training. This study identifies specific gaps in training on HIV prevention with PrEP that must be improved in health professions education to ensure PrEP reaches its full potential in ending the HIV epidemic.

Impact of pharmacist-led program on knowledge of college students about pre-exposure prophylaxis

OBJECTIVE

This study's primary objective was to evaluate the impact of a pharmacist-led educational program on undergraduate college students' knowledge about PrEP.

METHODS

This was a cross-sectional, pre- and postprogram survey study. The study included undergraduate students at least 18 years old at a university in Washington, DC. Graduate students, pharmacy students, and those not enrolled at the university were excluded. Before the educational program, the participants completed an anonymous preprogram survey to assess their perception and knowledge of HIV prevention and PrEP as well as their willingness to obtain a prescription for PrEP. A pharmacist delivered a 30-minute educational program to students regarding HIV prevention and PrEP in small groups. After the program, the participants completed a postprogram survey to evaluate the changes from the baseline responses. Paired t tests and chi-square tests detected the associations between the pre- and postprogram surveys.

RESULTS

One-hundred sixteen students participated in the program, and 102 surveys were included in the data analysis. Students' perception of their knowledge of HIV (4.2 vs. 4.6; P < 0.001), perception of their knowledge of PrEP (3.1 vs. 4.5; P < 0.001), and their willingness to obtain a prescription for PrEP (3.8 vs. 4.5; P < 0.001) was statistically significant after the education. There was a statistically significant increase in the participants' actual knowledge of HIV risk factors (62.4% correct vs. 90.2% correct; P < 0.001) and knowledge of PrEP effectiveness (26.3% vs. 75.0%; P < 0.001).

CONCLUSION

These findings demonstrated that a pharmacist-led educational program may have an impact on undergraduate students' perception and knowledge of HIV and PrEP. This study may help to further guide pharmacists' PrEP initiatives in this targeted population.

Intention-Based Critical Factors Affecting Willingness to Adopt Novel Coronavirus Prevention in Pakistan: Implications for Future Pandemics

Since human beings have a long tradition of coexistence with pandemics, which may profoundly impact them, adopting preventive measures is crucial for humankind's survival. This study explores the intention-based critical factors affecting the willingness of individuals to adopt pandemic prevention. To this end, a representative sample of 931 Pakistanis filled in an online questionnaire. However, only 828 questionnaires were found to be complete and valid for path modeling analysis. The core findings are as follows: Firstly, peer groups' beliefs, self-efficacy, perceived risk, pandemic knowledge, ease of pandemic prevention adoption, and risk-averse behavior are revealed as driving forces of the individuals' willingness to adopt pandemic prevention. Contrastingly, a lack of trust in political will and mythical attitude towards pandemics are uncovered as inhibitors. Nevertheless, moral values depict a neutral role. Secondly, the peer groups' beliefs are highest ranked, followed by the lack of trust in political will and a mythical attitude towards pandemic prevention. Finally, moral values are determined as the lowest-ranked critical factor. Based on these results, the government should promote awareness campaigns on lethality and fatality of the pandemic at both centralized and decentralized levels to win people's trust at the grass-roots level and overcome the mythical attitude of individuals at all societal levels. Besides, access to personal protective gears should be made feasible since an easier pandemic prevention adoption would increase the individuals' willingness to adopt such preventative measures.

Where Do Health Professions Students Learn About Pre-exposure Prophylaxis (PrEP) for HIV Prevention?

HIV pre-exposure prophylaxis (PrEP) is critical for ending the HIV epidemic, and a necessary part of health professions education. We present data from a US survey study (N = 2085) about educational experiences (coursework and extracurricular), in which medical, physician assistant, nursing, and pharmacy students received training about HIV risk factors and PrEP. We found a discrepancy between the percentage of courses covering HIV risk factors (84.7%) compared to PrEP (54.6%) for all students (P < .001), and specifically among final-year students (92.0% vs. 59.7%; P < .001). Pharmacology courses were the most common exposure to PrEP (46.0%), and 61.3% of students were introduced to PrEP through an extracurricular experience. Health professions education must present HIV risk factors in conjunction with PrEP.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01265-3.

Impact of pharmacist-led program on knowledge of college students about pre-exposure prophylaxis

OBJECTIVE

This study's primary objective was to evaluate the impact of a pharmacist-led educational program on undergraduate college students' knowledge about PrEP.

METHODS

This was a cross-sectional, pre- and postprogram survey study. The study included undergraduate students at least 18 years old at a university in Washington, DC. Graduate students, pharmacy students, and those not enrolled at the university were excluded. Before the educational program, the participants completed an anonymous preprogram survey to assess their perception and knowledge of HIV prevention and PrEP as well as their willingness to obtain a prescription for PrEP. A pharmacist delivered a 30-minute educational program to students regarding HIV prevention and PrEP in small groups. After the program, the participants completed a postprogram survey to evaluate the changes from the baseline responses. Paired t tests and chi-square tests detected the associations between the pre- and postprogram surveys.

RESULTS

One-hundred sixteen students participated in the program, and 102 surveys were included in the data analysis. Students' perception of their knowledge of HIV (4.2 vs. 4.6; P < 0.001), perception of their knowledge of PrEP (3.1 vs. 4.5; P < 0.001), and their willingness to obtain a prescription for PrEP (3.8 vs. 4.5; P < 0.001) was statistically significant after the education. There was a statistically significant increase in the participants' actual knowledge of HIV risk factors (62.4% correct vs. 90.2% correct; P < 0.001) and knowledge of PrEP effectiveness (26.3% vs. 75.0%; P < 0.001).

CONCLUSION

These findings demonstrated that a pharmacist-led educational program may have an impact on undergraduate students' perception and knowledge of HIV and PrEP. This study may help to further guide pharmacists' PrEP initiatives in this targeted population.

Perception-based influence factors of intention to adopt COVID-19 epidemic prevention in China

BACKGROUND

The researches investigating the influence factors of epidemic prevention are not only scarce, but also provide a gap in the domain of perception-based influence factors of intention to adopt COVID-19 epidemic prevention.

OBJECTIVE

This work has attempted to examine the perception-based influence factors of individuals' intention to adopt COVID-19 epidemic prevention in a modified behavioral framework.

THEORETICAL FRAMEWORK

A behavioral framework composed of the theory of reasoned action and the theory of planned behavior is developed to incorporate some additional perception-based influence factors.

METHODS

A partial least square-based path analysis has been employed to estimate the path coefficients of those factors in terms of drivers, barriers, and neutral factors based on questionnaire data of 302 respondents from six universities and two hospitals in China.

RESULTS

Among the perception-based influence factors, governments' guidelines on epidemic prevention is found to be the most important and influential factor, which was followed by risk perception. Finally, attitude towards epidemic prevention exhibited the least degree of impact on individuals' intention to adopt epidemic prevention. Moral norms did not show any contribution to individuals' intention to adopt epidemic prevention.

CONCLUSION

Concerning importance ranking, the governments' guidelines on epidemic prevention, risk perception, and epidemic knowledge are revealed as the top three drivers of individuals' intention to adopt epidemic prevention, while the perceived feasibility to adopt epidemic prevention is found to be a barrier. Moreover, moral norms is identified to have an insignificant influence on individuals' intention to adopt epidemic prevention. Given the empirical results, dissemination of Governments' guidelines on epidemic prevention, proper risk perception, and knowledge about epidemic would help prevent the COVID-19 pandemic outbreak within China and worldwide.

Student Education About Pre-exposure Prophylaxis (PrEP) Varies Between Regions of the United States

BACKGROUND

Daily, oral pre-exposure prophylaxis (PrEP) is an effective and safe prevention strategy for people at risk for HIV. However, prescription of PrEP has been limited for patients at the highest risk. Disparities in PrEP prescription are pronounced among racial and gender minority patients. A significant body of literature indicates that practicing healthcare providers have little awareness and knowledge of PrEP. Very little work has investigated the education about PrEP among health professionals in training.

OBJECTIVE

The objective of this study was to compare health professions students' awareness of PrEP and education about PrEP between regions of the US, and to determine if correlations between regional HIV incidence and PrEP use were present.

DESIGN

Survey study.

PARTICIPANTS

A cross-sectional sample of health professions students (N = 1859) representing future prescribers (MD, DO, PA), pharmacists, and nurses in the US.

KEY RESULTS

Overall, 83.4% of students were aware of PrEP, but only 62.2% of fourth-year students indicated they had been taught about PrEP at any time during their training. Education about PrEP was most comprehensive in the Northeastern US, the area with the highest PrEP to need ratio (4.7). In all regions, transgender patients and heterosexual men and women were least likely to be presented in education as PrEP candidates, and men who have sex with men were the most frequently presented.

CONCLUSIONS

There are marked differences in education regarding PrEP both between academic programs and regions of the USA.

Knowledge, Attitudes, and Intentions towards HIV Pre-Exposure Prophylaxis among Nursing Students in Spain

Human immunodeficiency virus (HIV) infection is one of the main causes of morbidity and mortality worldwide. Among the preventive approaches proposed to control this disease is pre-exposure prophylaxis (PrEP), whose effectiveness depends on the medication adherence. The aim of the present study was to determine the knowledge and attitudes about PrEP among a sample of Spanish nursing students as well as their intentions of receiving it in case it was indicated. An observational cross-sectional descriptive study was carried out. A total of 570 nursing students from the University of Santiago de Compostela (Spain), ≥18 years old and of both sexes were invited to self-complete a questionnaire between February and March 2020. A total of 352 students decided to participate in the study. Participants had low knowledge [overall knowledge score 1(0-2)] and a neutral attitude towards PrEP. The intention of receiving PrEP improved significantly after the completion of the questionnaire and the administration of information about PrEP (p = 0.039; before: 23.58% and after: 93.77%). Nursing staff play an important role in the prevention of sexually transmitted diseases, so their training in preventive strategies, such as PrEP, could help to reduce the incidence of new cases of HIV infection.

HIV Pre-Exposure Prophylaxis Implementation Cascade Among Health Care Professionals in the United States: Implications from a Systematic Review and Meta-Analysis

Although pre-exposure prophylaxis (PrEP) has been approved for primary HIV prevention for individuals aged 18 years or older since 2012, PrEP utilization has been suboptimal. To understand trends in PrEP provision from the health care providers' perspective, we systematically assessed each specific stage along the PrEP implementation cascade (i.e., awareness, willingness, consultation, and prescription) among health care professionals (HCPs) in the United States. Between June and December 2018, we conducted a systematic review of published studies on this topic. A total of 36 eligible studies were identified and included in the analyses. Random-effect models were employed to examine the pooled prevalence of each key stage along the cascade. Time trend and subgroup analyses were conducted. A thematic analysis was used to identify barriers and facilitators along the PrEP cascade. In this study, a total of 18,265 HCPs representing diverse demographics were included. The pooled prevalence of PrEP awareness was 68% [95% confidence interval (CI) = 55-80%], willingness to prescribe PrEP was 66% (95% CI = 54-77%), PrEP consultation was 37% (95% CI = 25-51%), and prescription provision was 24% (95% CI = 17-32%). Subgroup analyses revealed that PrEP provision among HCPs was lowest in the south, but has been improving annually nationwide. Infectious disease specialists [odds ratio (OR) = 4.06, 95% CI = 3.12-5.28; compared with primary care providers] and advanced practice registered nurses/physician assistants (OR = 1.51, 95% CI = 1.09-2.09; compared with physicians) had higher odds of prescribing PrEP. Barriers and facilitators regarding optimal PrEP implementation were embedded within individual, dyadic, social, and structural levels. This meta-analysis has comprehensively examined the trend and pattern of PrEP implementation among HCPs. To achieve optimal implementation of the PrEP cascade in the United States, tailored training and programs need to be provided to HCPs.