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Martínez-Cajas J, Alvarado-Llano B, Martínez-Buitrago E, Torres-Isasiga J, Arrivillaga M, Camargo P, Galindo-Orrego X, Mueses-Marín H. AC-2020-12-1420.R1 - HIV care providers' familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study. AIDS Care 2022; 34:1428-1434. [PMID: 35067114 DOI: 10.1080/09540121.2022.2029813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In 2019, Colombia approved the combination of tenofovir disoproxil fumarate/emtricitabine for HIV Pre-Exposure Prophylaxis (PrEP). Therefore, we conducted a situational analysis in HIV-care providers to identify barriers and facilitators for PrEP implementation. A survey was applied to a non-probabilistic sample of health care workers of HIV-specialized clinics. We examined PrEP awareness and familiarity, comfort with PrEP-related activities, perceived barriers for PrEP implementation, concerns, and attitudes. Poisson regressions assessed the relationship between these factors and the variable "having a plan to offer PrEP". The participation rate was 41% and included physicians (42.6%) and other health professionals (57.4%). Fifty-one percent of the participants reported more than five years of experience caring for people living with HIV. Forty-two percent of non-physician health care workers were nurses. Most reported high familiarity/comfort with PrEP-relevant activities. Concerns about PrEP were prevalent (> 50%) and included causing more harm than good, reducing condom use, medication non-adherence, drug resistance, and healthcare system barriers. Physicians had a plan to offer PrEP (72.2%) more often than other health professionals (52.6). Having a plan to offer PrEP was related to PrEP knowledge and comfort assessing sexual behavior and providing HIV counseling. Overall, about half of HIV-care providers seemed ready to offer PrEP and constitute an asset for PrEP implementation efforts in Colombia. PrEP awareness among non-physicians, PrEP concerns, and negative attitudes need to be addressed to enhance implementation.
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Affiliation(s)
| | | | - Ernesto Martínez-Buitrago
- Hospital Universitario del Valle Evaristo García, Unidad de Epidemiología, Universidad del Valle, Cali, Colombia
| | - Julian Torres-Isasiga
- Albert Einstein College of Medicine and Montefiore Medical Center, Division of Infectious Diseases, Bronx, NY, USA
| | | | - Pilar Camargo
- Queen's University, School of Nursing. Kingston Ontario, Canada
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North S, Sandset TJ, Olsen AO. A cross-sectional survey of general practitioner knowledge, attitudes, and clinical experience of HIV PrEP. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Aim
Norway’s health scheme provides no-cost HIV pre-exposure prophylaxis (PrEP) when prescribed by a specialist, typically preceded by a general practitioner’s (GP) referral. The GP perspective with regard to PrEP implementation in Norway has yet to be captured.
Subject and methods
We explored PrEP knowledge, attitudes, and clinical experience of GPs in the Norwegian capital of Oslo, where HIV incidence and PrEP demand are highest. An anonymous survey was designed and distributed between November 2019 and February 2020. Univariate and multivariate logistic regression analyses were performed to identify determinants of GPs’ previous clinical PrEP experience (PrEP adoption).
Results
One hundred and seventeen GPs responded to the survey. GP PrEP adopters were more likely to: identify as men (aOR 2.1; 95% CI: 1.0–4.5); identify as lesbian, gay, or bisexual (LGB) (aOR 4.4; 95% CI: 1.4–14.5); have ≥ 10 LGB identifying patients on their list (aOR 4.4; 95% CI:1.8–10.4); and self-report higher levels of PrEP knowledge (aOR 2.4; 95% CI: 1.3–4.4).
Conclusion
Our findings suggest that GP PrEP knowledge is crucial to patient PrEP access. Educational interventions ought to be considered to enhance GP PrEP adoption capacities, such as easy-to-access PrEP guidelines and peer-based training opportunities in both online and in-person formats.
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RICCARDI NICCOLÒ, CENDERELLO GIOVANNI, CROCE DAVIDE, DI PERRI GIOVANNI, RIZZARDINI GIULIANO, MARTINI MARIANO, DI BIAGIO ANTONIO. Nine ideas to improve the clinical management of HIV infected patients during the COVID-19 pandemic. J Prev Med Hyg 2021; 62:E30-E33. [PMID: 34622081 PMCID: PMC8452289 DOI: 10.15167/2421-4248/jpmh2021.62.1s3.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/20/2021] [Indexed: 11/20/2022]
Abstract
Globally, in 2019, HIV infection was still responsible for 1.7 million new infections and for 690,000 deaths in the same year. Tailored and new antiretroviral therapy (ART) regimens, individualised follow-up and new technologies to support data-sharing between health-care professional caring for people living with HIV (PLHIV) and to deliver ART to patients are desperately needed to reach the 90-90-90-90 ambitious goals. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, responsible for the Coronavirus-19 (COVID-19) pandemic that spread globally in 2020, posed a huge challenge for PLHIV and HIV physicians worldwide in terms of continuum of care. In this paper we encourage “up-to-date patient-centred HIV medicine” and we give nine ideas to improve HIV management in clinical practice during the COVID-19 pandemic.
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Affiliation(s)
- NICCOLÒ RICCARDI
- StopTB Italia Onlus, Milan, Italy
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
- Correspondence: Niccolò Riccardi, Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy - Tel.: +39 045 601 4620 - E-mail:
| | - GIOVANNI CENDERELLO
- Infectious Diseases, Department of Graduated Medical Care, Sanremo Hospital, Sanremo, Italy
| | - DAVIDE CROCE
- Centre for Research on Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - GIOVANNI DI PERRI
- Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - GIULIANO RIZZARDINI
- Fatebenefratelli Sacco Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - ANTONIO DI BIAGIO
- Infectious Disease, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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Voglino G, Gualano MR, Rousset S, Forghieri P, Fraire I, Bert F, Siliquini R. Knowledge, Attitudes and Practices Regarding Pre-Exposure Prophylaxis (PrEP) in a Sample of Italian Men Who Have SEX with MEN (MSM). Int J Environ Res Public Health 2021; 18:4772. [PMID: 33947130 PMCID: PMC8124277 DOI: 10.3390/ijerph18094772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is suitable for high human immunodeficiency virus (HIV)-infection risk people, foremost among whom are males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. No previous study has assessed this issue; Methods: An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour and habits, HIV/acquired immune deficiency syndrome (AIDS) knowledge and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify factors associated with PrEP knowledge; Results: A total of 196 MSM participated in this survey. Overall data showed that 87.2% of participants knew what PrEP is, but only 7.5% have ever used it. The main reason for not using PrEP was the cost of the therapy (26.9%). The principal source of PrEP information was the Internet (68.4%). Being regularly tested for HIV was significantly associated with PrEP knowledge (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29); Conclusions: Knowledge regarding PrEP was well established, but PrEP use was not equally widespread. It is necessary to improve research on PrEP usage in order to PrEP access to be granted.
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Affiliation(s)
- Gianluca Voglino
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Maria Rosaria Gualano
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Stefano Rousset
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Pietro Forghieri
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Isabella Fraire
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Fabrizio Bert
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
- AOU City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
- AOU City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy
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FERRARIO LUCREZIA, FOGLIA EMANUELA, GARAGIOLA ELISABETTA, PACELLI VALERIA, CENDERELLO GIOVANNI, DI BIAGIO ANTONIO, RIZZARDINI GIULIANO, ERRICO MARGHERITA, IARDINO ROSARIA, CROCE DAVIDE. The impact of PrEP: results from a multicenter Health Technology Assessment into the Italian setting. J Prev Med Hyg 2020; 61:E451-E463. [PMID: 33150233 PMCID: PMC7595079 DOI: 10.15167/2421-4248/jpmh2020.61.3.1352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/01/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The use of oral tenofovir/emtricitabine (FTC/TDF) for pre-exposure prophylaxis (PrEP) among high-risk people without Human Immunodeficiency Virus (HIV), is emerging as an innovative strategy to decrease HIV epidemic. The study aims at evaluating the implications related to PrEP introduction, from a multidimensional point of view, as required by Health Technology Assessment (HTA) approach, with a particular attention on sustainability and social factors, influencing PrEP implementation. METHODS An analysis was conducted involving 35 Italian Infectious Disease Departments. The introduction of PrEP (applied both as "add-on" and "substitute" prevention strategy) into the clinical practice was compared with a baseline scenario, consisting of condoms among men who have sex with men, and serodiscordant couples, and the use of Needle Syringe Programme among injection drugs users The above scenarios were analysed by means of a Health Technology Assessment (HTA) approach. The 9 EUnetHTA Core Model domains were assessed through comparative information, retrieved from literature evidence, and collection of qualitative and quantitative information, derived from real-world evidence, in particular from 35 Infectious Disease Departments and potential PrEP' users involved. A final multi-criteria decision analysis approach (MCDA) was implemented to simulate the appraisal phase and providing evidence-based information with regard to the preferable technology. RESULTS Despite the improvement in patients' quality of life, PrEP would generate the development of other sexually transmitted and blood-borne diseases, with a consequent decrease of patients' safety in case of PrEP applied as a "substitute" prevention strategy. In addition, PrEP would generate an increase in staff workflow, with investment in medical supplies and training courses. PrEP would lead to significant economic investments both for the NHS (+40%), and for citizens (+2,377%) if used as an add-on strategy, assuming FTC/TDF patent cost. With the off-patent drug, the NHS would benefit from an advantage (37%), and a shrink of the patients' expenditure emerged (+682%). More economic resources are required if PrEP is applied as a substitute strategy, considering both the patent (NHS: 212%; citizens: 3,423%) and the off-patent drug (NHS: 73%; citizens: 1,077%). Conclusions. The most cost-containing strategy would be the use of PrEP, as an add-on strategy, with a consequent improvement in patients' safety, even if drug-related adverse events would be considered. The implementation of the off-patent drug would decrease the economic burden of the innovative prevention strategy. Hence, the organizational aspects related to its adoption would be deeply investigated, with the potential opportunity to create specific ambulatories devoted to PrEP users' especially for medium and big size hospitals.
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Affiliation(s)
- LUCREZIA FERRARIO
- MEcon, Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - EMANUELA FOGLIA
- MEcon, Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - ELISABETTA GARAGIOLA
- MEcon, Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - VALERIA PACELLI
- MEcon, Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - GIOVANNI CENDERELLO
- Galliera Hospital, Department of Infectious Diseases, Genova, Italy - ASL-1 Imperiese Hospital, Department of Infectious Diseases, Sanremo, Italy
| | - ANTONIO DI BIAGIO
- Policlinico San Martino Hospital, Unit of Infectious Diseases, Genova, Italy
| | - GIULIANO RIZZARDINI
- Fatebenefratelli Sacco Hospital, Department of Infectious Diseases, Milan, Italy - School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - DAVIDE CROCE
- MEng, Centre for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy - School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Plomer AS, McCool-Myers M, Apfelbacher C. Perspectives on HIV PrEP care in Germany: qualitative insights from primary care physicians and specialists. AIDS Care 2020; 32:994-1000. [PMID: 32539453 DOI: 10.1080/09540121.2020.1778626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recently, research has shifted from investigating the effectiveness of HIV pre-exposure prophylaxis (PrEP) to strategizing its implementation. Several European studies have explored physicians' perspectives on implementing PrEP in diverse settings, yet there are no data on the situation in Germany. The purpose of this study was to explore physicians' perspectives on current PrEP care in Germany. From April to July 2018, we conducted 16 semi-structured interviews with HIV providers (HIVPs) and primary care physicians (PCPs). Transcripts were analyzed using thematic content analysis. Physicians showed varying levels of PrEP expertise. Many PCPs lacked knowledge about PrEP. Some PCPs did not support the idea of PrEP as a prophylactic option. Opinions about PCPs' role in PrEP care were diverging, yet most PCPs favored referring PrEP clients to an HIVP or opted for a shared-care arrangement. Perceived problems included stigma and lack of privacy for PrEP care in rural areas. Our findings highlight the need for tailored physician training, which should be addressed in PrEP implementation in Germany.
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Affiliation(s)
- Anna-Sophie Plomer
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University, Atlanta, GA, USA
| | - Christian Apfelbacher
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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