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Health practitioners are divided on the opinions of providers about prescribing pre-exposure prophylaxis (PrEP), which is given to people at high risk of acquiring HIV.
This is the conclusion of a new study by researchers at the University of Buffalo (UB), who interviewed PrEP prescribing service providers to conduct a qualitative badysis of their perspectives on HIV / AIDS. preventive treatment. Their article was published online before printing earlier this month in the Journal of the Association of Nurses in AIDS Care.
In a separate study, UB researchers also surveyed pharmacy students about their knowledge and perspectives on the drug. "Understanding the barriers and facilitators to PrEP adoption and implementation by current and future healthcare providers is critical to accelerate the deployment of this preventive drug to populations that meet the clinical eligibility criteria." said Sarahmona Przybyla, the lead author of the study. Przybyla is an Assistant Professor in Community Health and Health Behavior at the UB School of Public Health and Health Professions.
Who should prescribe PrEP?
In the United States, more than 1.1 million people are living with HIV and 38,500 new infections occur each year. It has been seven years since the US Food and Drug Administration approved PrEP for use in adults and one year in adolescents. Nevertheless, previous research has shown that the adoption of PrEP did not meet expectations. For example, the US Centers for Disease Control and Prevention (CDC) estimate that 1.2 million Americans are eligible for the drug, but only 150,000 take it.
PrEP is only available for HIV-negative people. There is a debate – called the "paradox of competence" – in the health care and public health community about who should prescribe PrEP. HIV specialists are probably the most willing and able to prescribe PrEP, but they generally do not see patients who are not infected with HIV. Meanwhile, primary care physicians are more likely to see patients eligible for PrEP, but GPs may not have the training and skills to prescribe it.
It is in this spirit that Przybyla and his team interviewed a small sample of clinicians from Erie and Niagara counties, in western New York, authorized to prescribe drugs in New York that had prescribed PrEP for at least three months.
Participants were almost equally divided into types of ideal providers: 15 chose primary care physicians, while 13 reported any health care provider. None of the participants indicated preference for specialists in infectious diseases or HIV. This is probably due to the fact that there are approximately 8,500 infectious disease specialists in the United States, which is insufficient to treat the 1 million people who meet the eligibility criteria for PrEP.
Previous studies of patients and health care providers have shown that primary care physicians are the preferred providers, mainly because they are more available and accessible and are more likely to see patients over a long period of time. period.
According to Przybyla, clinicians are key players in PrEP engagement with patients at risk for HIV infection. "This research supports a growing research base that warrants continued efforts to integrate PrEP into a comprehensive HIV prevention plan at local, regional and national levels."
PrEP survey of Rx students
Przybyla is also the author of the first article to interview pharmacy students about their knowledge and attitudes towards PrEP. The study of 291 students enrolled in the PharmD program at UB's School of Pharmacy and Pharmaceutical Sciences revealed that:
- 89% think PrEP can be a cost-effective tool for preventing HIV infection
- 12% felt that PrEP is too expensive to justify its use
- 16% felt that people to whom the drug had been prescribed would not take it regularly
- 64% thought they could advise patients on PrEP
- 87% said they intend to advise patients about the drug
Other studies have examined the attitudes of pharmacists, physicians, nurse practitioners and medical badistants, as well as medical students, with regard to PrEP, but none has interviewed pharmacy students, said Przybyla. The study, published online before publication in the journal Currents in teaching and learning pharmacy, reveals the need to intensify educational efforts to improve the knowledge of pharmacy students on the CDC's prescribing guidelines for the drug.
For example, 40% of respondents – a higher proportion than in previous studies of health care providers – mistakenly thought that widespread use of PrEP could significantly increase antiretroviral resistance rates. The researchers note that the CDC guidelines for clinicians provide detailed evidence that drug-resistant mutations are rare.
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