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HIV Post-Exposure Prophylaxis (PEP) Awareness and Non-Occupational PEP (nPEP) Prescribing History Among U.S. Healthcare Providers

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Abstract

Non-occupational post-exposure prophylaxis (nPEP) has been clinically recommended since 2005. HIV providers and non-HIV providers (n = 480) practicing within above-average HIV prevalence ZIP codes of the 10 U.S. cities with greatest overall HIV prevalence participated in a cross-sectional survey between July 2014 and May 2015. Providers were asked about their awareness of post-exposure prophylaxis (PEP) and nPEP prescribing experience for patients with potential sexual exposures to HIV, which we coded into a PEP prescribing cascade with three categories: (1) PEP unaware, (2) PEP aware, no nPEP prescribing experience, and (3) nPEP prescribing experience. Overall, 12.5% were unaware of PEP, 43.5% were aware but hadn’t prescribed nPEP, and 44.0% had prescribed nPEP for potential sexual exposures to HIV. Fewer providers practicing in the U.S. South had ever prescribed nPEP compared to providers in other regions (χ2= 39.91, p < 0.001). HIV providers, compared to non-HIV providers, were more likely to be classified in the nPEP prescription group compared to the PEP aware without nPEP prescription group (RRR = 2.96, p < 0.001). PrEP prescribers, compared to those PrEP unaware, were more likely to be classified in the nPEP prescription group compared to PEP aware without nPEP prescription group (RRR = 12.49, p < 0.001).

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References

  1. Centers for Disease Control and Prevention. HIV surveillance report, 2017, vol. 29. 2018; Available at: https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 6 Aug 2019.

  2. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: A plan for the United States. JAMA. 2019;321(9):844–5.

    PubMed  Google Scholar 

  3. Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. New Engl J Med. 2012;367(5):399–410.

    CAS  PubMed  Google Scholar 

  4. Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–90.

    PubMed  Google Scholar 

  5. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New Engl J Med. 2010;363(27):2587–99.

    CAS  PubMed  Google Scholar 

  6. Marrazzo JM, Ramjee G, Richardson BA, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. New Engl J Med. 2015;372(6):509–18.

    PubMed  Google Scholar 

  7. Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. New Engl J Med. 2012;367(5):423–34.

    CAS  PubMed  Google Scholar 

  8. Van Damme L, Corneli A, Ahmed K, et al. Preexposure prophylaxis for HIV infection among African women. New Engl J Med. 2012;367(5):411–22.

    PubMed  Google Scholar 

  9. Molina JM, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46.

    CAS  PubMed  Google Scholar 

  10. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53–60.

    PubMed  PubMed Central  Google Scholar 

  11. Molina J-M, Charreau I, Spire B, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402–e410410.

    PubMed  Google Scholar 

  12. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.

    PubMed  Google Scholar 

  14. Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV. 2018;5(8):e438–e447447.

    PubMed  Google Scholar 

  15. Rodger AJ, Cambiano V, Bruun T, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): Final results of a multicentre, prospective, observational study. Lancet. 2019;393(10189):2428–38.

    PubMed  PubMed Central  Google Scholar 

  16. Beymer MR, Weiss RE, Bolan RK, et al. Differentiating nonoccupational postexposure prophylaxis seroconverters and non-seroconverters in a community-based clinic in Los Angeles, California. Open Forum Infect Dis. 2017;4(2):ofx061.

    PubMed  PubMed Central  Google Scholar 

  17. Donnell D, Mimiaga MJ, Mayer K, Chesney M, Koblin B, Coates T. Use of non-occupational post-exposure prophylaxis does not lead to an increase in high risk sex behaviors in men who have sex with men participating in the EXPLORE trial. AIDS Behav. 2010;14(5):1182–9.

    PubMed  PubMed Central  Google Scholar 

  18. Foster R, McAllister J, Read TR, et al. Single-tablet emtricitabine-rilpivirine-tenofovir as HIV postexposure prophylaxis in men who have sex with men. Clin Infect Dis. 2015;61(8):1336–411.

    CAS  PubMed  Google Scholar 

  19. Jain S, Oldenburg CE, Mimiaga MJ, Mayer KH. Subsequent HIV infection among men who have sex with men who used non-occupational post-exposure prophylaxis at a Boston community health center: 1997–2013. AIDS Patient Care STDS. 2015;29(1):20–5.

    PubMed  PubMed Central  Google Scholar 

  20. McAllister J, Read P, McNulty A, Tong WW, Ingersoll A, Carr A. Raltegravir-emtricitabine-tenofovir as HIV nonoccupational post-exposure prophylaxis in men who have sex with men: Safety, tolerability and adherence. HIV Med. 2014;15(1):13–22.

    CAS  PubMed  Google Scholar 

  21. Schechter M, do Lago RF, Mendelsohn AB, Moreira RI, Moulton LH, Harrison LH. Behavioral impact, acceptability, and HIV incidence among homosexual men with access to postexposure chemoprophylaxis for HIV. J Acquir Immune Defic Syndr. 2004;35(5):519–25.

    PubMed  Google Scholar 

  22. Sonder GJ, Prins JM, Regez RM, et al. Comparison of two HIV postexposure prophylaxis regimens among men who have sex with men in Amsterdam: adverse effects do not influence compliance. Sex Transm Dis. 2010;37(11):681–6.

    CAS  PubMed  Google Scholar 

  23. Smith DK, Grohskopf LA, Black RJ, et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the US Department of Health and Human Services. Morb Mortal Wkly Rep. 2005;54(Rr-2):1–20.

    Google Scholar 

  24. Ford N, Mayer KH. World Health Organization guidelines on postexposure prophylaxis for HIV: recommendations for a public health approach. Clin Infect Dis. 2015;60(Suppl 3):S161–164.

    PubMed  Google Scholar 

  25. Centers for Disease Control and Prevention. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016. 2016. Available at: https://www.cdc.gov/hiv/pdf/programresources/cdc-hiv-npep-guidelines.pdf. Accessed 14 Feb 2017.

  26. Mayer KH, Jones D, Oldenburg C, et al. Optimal HIV postexposure prophylaxis regimen completion with single tablet daily elvitegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine compared with more frequent dosing regimens. J Acquir Immune Defic Syndr. 2017;75(5):535–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Blumenthal J, Jain S, Mulvihill E, et al. Perceived Versus Calculated HIV risk: implications for pre-exposure prophylaxis uptake in a randomized trial of men who have sex with men. J Acquir Immune Defic Syndr. 2019;80(2):e23–e2929.

    PubMed  PubMed Central  Google Scholar 

  28. Underhill K, Guthrie KM, Colleran C, Calabrese SK, Operario D, Mayer KH. Temporal fluctuations in behavior, perceived HIV risk, and willingness to use pre-exposure prophylaxis (PrEP). Arch Sex Behav. 2018;47(7):2109–21.

    PubMed  PubMed Central  Google Scholar 

  29. Whitfield THF, John SA, Rendina HJ, Grov C, Parsons JT. Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS Behav. 2018;22(11):3566–75.

    PubMed  PubMed Central  Google Scholar 

  30. Blackstock OJ, Moore BA, Berkenblit GV, et al. A cross-sectional online survey of HIV pre-exposure prophylaxis adoption among primary care physicians. J Gen Intern Med. 2017;32(1):62–70.

    PubMed  Google Scholar 

  31. Blumenthal J, Jain S, Krakower D, et al. Knowledge is power! Increased provider knowledge scores regarding pre-exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP. AIDS Behav. 2015;19(5):802–10.

    PubMed  PubMed Central  Google Scholar 

  32. Castel AD, Feaster DJ, Tang W, et al. Understanding HIV care provider attitudes regarding intentions to prescribe PrEP. J Acquir Immune Defic Syndr. 2015;70(5):520–8.

    PubMed  PubMed Central  Google Scholar 

  33. Clement ME, Seidelman J, Wu J, et al. An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S. AIDS Care. 2018;30(5):650–5.

    PubMed  Google Scholar 

  34. Hakre S, Blaylock JM, Dawson P, et al. Knowledge, attitudes, and beliefs about HIV pre-exposure prophylaxis among US Air Force Health Care Providers. Medicine. 2016;95(32):e4511.

    PubMed  PubMed Central  Google Scholar 

  35. Ojile N, Sweet D, Kallail KJ. A preliminary study of the attitudes and barriers of family physicians to prescribing HIV preexposure prophylaxis. Kans J Med. 2017;10(2):40–2.

    PubMed  PubMed Central  Google Scholar 

  36. Pleuhs B, Quinn KG, Walsh JL, Petroll AE, John SA. Health care provider barriers to HIV pre-exposure prophylaxis in the United States: a systematic review. AIDS Patient Care and STDs. 2020;34(3):111–23.

    PubMed  Google Scholar 

  37. Seidman D, Carlson K, Weber S, Witt J, Kelly PJ. United States family planning providers' knowledge of and attitudes towards preexposure prophylaxis for HIV prevention: a national survey. Contraception. 2016;93(5):463–9.

    PubMed  Google Scholar 

  38. Terndrup C, Streed CG Jr, Tiberio P, et al. A cross-sectional survey of internal medicine resident knowledge, attitudes, behaviors, and experiences regarding pre-exposure prophylaxis for HIV infection. J Gen Intern Med. 2019;34(7):1258–78.

    PubMed  PubMed Central  Google Scholar 

  39. Tripathi A, Ogbuanu C, Monger M, Gibson JJ, Duffus WA. Preexposure prophylaxis for HIV infection: Healthcare providers' knowledge, perception, and willingness to adopt future implementation in the southern US. South Med J. 2012;105(4):199–206.

    PubMed  Google Scholar 

  40. Wood BR, McMahan VM, Naismith K, Stockton JB, Delaney LA, Stekler JD. Knowledge, practices, and barriers to HIV preexposure prophylaxis prescribing among Washington State medical providers. Sex Transm Dis. 2018;45(7):452–8.

    PubMed  Google Scholar 

  41. Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS Behav. 2017;21(5):1256–67.

    PubMed  PubMed Central  Google Scholar 

  42. Walsh JL, Petroll AE. Factors related to pre-exposure prophylaxis prescription by U.S. primary care physicians. Am J Prev Med. 2017;52(6):e165–e172172.

    PubMed  PubMed Central  Google Scholar 

  43. Smith DK, Mendoza MC, Stryker JE, Rose CE. PrEP Awareness and attitudes in a national survey of primary care clinicians in the United States, 2009–2015. PLoS ONE. 2016;11(6):e0156592.

    PubMed  PubMed Central  Google Scholar 

  44. AIDSVu. Mapping PrEP: First ever data on PrEP users across the U.S. 2018. Available at: https://aidsvu.org/prep/. Accessed 8 Mar 2018.

  45. Henny KD, Duke CC, Geter A, et al. HIV-related training and correlates of knowledge, HIV screening and prescribing of nPEP and PrEP among primary care providers in Southeast United States, 2017. AIDS Behav. 2019;23(11):2926–35.

    PubMed  PubMed Central  Google Scholar 

  46. Rodriguez AE, Castel AD, Parish CL, et al. HIV medical providers' perceptions of the use of antiretroviral therapy as nonoccupational postexposure prophylaxis in 2 major metropolitan areas. J Acquir Immune Defic Syndr. 2013;64(Suppl 1):S68–79.

    CAS  PubMed  Google Scholar 

  47. Gilman B, Bouchery E, P. H, Negrusa S, Trent-Adams S, Cheever L. The HIV clinician workforce in the United States. HIV Specialist. 2016. Available at https://aahivm.org/wp-content/uploads/2017/03/FINAL-August-2016.pdf. Accessed 15 Jan 2020.

  48. Association of American Medical Colleges. 2018 Physician specialty data report. 2019. Available at: https://www.aamc.org/data/workforce/reports/492536/2018-physician-specialty-data-report.html. Accessed 17 Sep 2019.

  49. Zablotska IB, Prestage G, Holt M, et al. Australian gay men who have taken nonoccupational postexposure prophylaxis for HIV are in need of effective HIV prevention methods. J Acquir Immune Defic Syndr. 2011;58(4):424–8.

    PubMed  Google Scholar 

  50. Grant RM, Smith DK. Integrating antiretroviral strategies for human immunodeficiency virus prevention: Post- and pre-exposure prophylaxis and early treatment. Open Forum Infect Dis. 2015;2(4):ofv126.

    PubMed  PubMed Central  Google Scholar 

  51. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.

    CAS  PubMed  Google Scholar 

  52. Krakower DS, Ware N, Mitty JA, Maloney K, Mayer KH. HIV providers' perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: A qualitative study. AIDS Behav. 2014;18(9):1712–21.

    PubMed  PubMed Central  Google Scholar 

  53. Krakower DS, Ware NC, Maloney KM, Wilson IB, Wong JB, Mayer KH. Differing experiences with pre-exposure prophylaxis in Boston among lesbian, gay, bisexual, and transgender specialists and generalists in primary care: Implications for scale-up. AIDS Patient Care STDS. 2017;31(7):297–304.

    PubMed  PubMed Central  Google Scholar 

  54. Siegler AJ, Mouhanna F, Giler RM, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis–to-need ratio in the fourth quarter of 2017 United States. Ann Epidemiol. 2018;28(12):841–9.

    PubMed  PubMed Central  Google Scholar 

  55. Association of Amercian Medical Colleges. 2019 Update: The complexities of physician supply and demand: Projections from 2017 to 2032. 2019. Available at: https://aamc-black.global.ssl.fastly.net/production/media/filer_public/31/13/3113ee5c-a038-4c16-89af-294a69826650/2019_update_-_the_complexities_of_physician_supply_and_demand_-_projections_from_2017-2032.pdf. Accessed 17 Sep 2019.

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Acknowledgements

The authors acknowledge the contributions of other members of the study team, especially Drs. Jill Owczarzak, Timothy McAuliffe, Laura Bogart, and Jeffrey Kelly. We also thank our staff at the Center for AIDS Intervention Research and our participants who volunteered their time. This work was presented in part at the International Association of Providers of AIDS Care (IAPAC) Conference; June 17–19, 2019; Miami, FL.

Funding

Funding support was provided by Gilead Sciences, Inc. (IN-US-276–0123, PI: Petroll) and the National Institute of Mental Health (P30-MH052776, PI: Kelly; K01-MH118939, PI: John; K01-MH112412, PI: Quinn). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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  1. Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA

    Steven A. John, Katherine G. Quinn, Benedikt Pleuhs, Jennifer L. Walsh & Andrew E. Petroll

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  1. Steven A. John
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Correspondence to Steven A. John.

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AEP receives research funding from Gilead Sciences, Inc. All other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This study met the Medical College of Wisconsin Institutional Review Board’s definition of “minimal risk” and a waiver of informed consent was granted.

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John, S.A., Quinn, K.G., Pleuhs, B. et al. HIV Post-Exposure Prophylaxis (PEP) Awareness and Non-Occupational PEP (nPEP) Prescribing History Among U.S. Healthcare Providers. AIDS Behav 24, 3124–3131 (2020). https://doi.org/10.1007/s10461-020-02866-6

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