Currently submitted to: Journal of Medical Internet Research
Date Submitted: Sep 10, 2020
Open Peer Review Period: Sep 10, 2020 - Nov 5, 2020
(currently open for review)
Clinicians are Inclined to Prescribe HIV Pre-Exposure Prophylaxis for Persons at High HIV Risk but are Concerned about the Lack of Guidelines: A National Survey in China
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention measure. Clinicians play crucial role in PrEP implementation, and their knowledge, attitudes, career experience, and related structural factors may affect their willingness to prescribe PrEP. However, little is known about the attitudes and willingness of clinicians to prescribe PrEP without guidelines.
We aimed to explore clinicians associated factors for their willingness to prescribe PrEP in China.
Between May and June 2019, a nationwide online cross-sectional survey of clinicians was conducted on the platform of WeChat smartphone application. Multivariate logistic regression was used to assess factors associated with willingness to prescribe PrEP.
Overall, 777 HIV clinicians from 31 provinces in six administrative regions of China completed the survey. It was found that 72.5% of respondents had heard of PrEP, 32.9% thought that PrEP could effectively prevent HIV acquisition in key populations, and 47.2% thought that it was necessary to provide PrEP services to key populations. After adjusting for age, gender, ethnicity and education level, the following factors signiﬁcantly increased the odds of PrEP prescription: having worked for more than 10 years (AOR = 2.82), having serviced more than 100 patients per month (AOR = 4.16), and often encountering key populations seeking the PrEP prescription service (AOR = 79.35). The barriers of PrEP willingness prescribing were concerning about poor adherence to PrEP (AOR = 0.66), lacking of clinical guidelines for PrEP (AOR = 0.47), and lacking of drug indications for PrEP (AOR = 0.49).
A high proportion of clinicians are willing to prescribe PrEP, but their understanding of PrEP is poor. Lack of PrEP clinical guidelines, lack of drug indications, and employees with limited work experience are the main barriers to the willingness of PrEP prescription. The development of PrEP clinical guidelines and drug indications and the availability of PrEP training are recommended to improve understanding and the willingness to prescribe PrEP.
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