AUTHOR=Bil Janneke P. , Hoornenborg Elske , Prins Maria , Hogewoning Arjan , Dias Goncalves Lima Fernando , de Vries Henry J. C. , Davidovich Udi 

TITLE=The Acceptability of Pre-Exposure Prophylaxis: Beliefs of Health-Care Professionals Working in Sexually Transmitted Infections Clinics and HIV Treatment Centers

JOURNAL=Frontiers in Public Health

VOLUME=Volume 6 - 2018

YEAR=2018

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2018.00005

DOI=10.3389/fpubh.2018.00005

ISSN=2296-2565

ABSTRACT=Background: Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV infection, but is not yet implemented in the Netherlands. As the attitudes of healthcare professionals towards PrEP can influence future PrEP implementation, we studied PrEP knowledge and beliefs and their association with PrEP acceptability among professionals in clinics for sexually transmitted infections (STI professionals) and HIV treatment centers (HIV specialists). Additionally, we examined preferred regimens, attitudes towards providing PrEP to key populations and to reimbursement of PrEP costs.
Methods: An online questionnaire was distributed among 24 public health STI clinics and 27 HIV treatment centers nation-wide in the Netherlands between January and August 2015. Acceptability of PrEP was measured on a 7-point Likert scale ranging from 1=low to 7=high acceptability. Univariable and multivariable linear regression analyses were used to explore associations between demographic characteristics, PrEP knowledge, beliefs about PrEP and PrEP acceptability.
Results: In total, 209 people (143 STI professionals and 66 HIV specialists) completed the questionnaire. The mean acceptability of PrEP implementation was 4.28 (SD 1.68) among STI professionals and 4.42 (SD 1.67) among HIV specialists. The mean score on self-perceived knowledge related to PrEP efficacy was 3.90 (SD 1.57) among STI professionals and 5.68 (SD 1.08) among HIV specialists (p-value<0.001). Beliefs associated with lower PrEP acceptability among both groups were the fear that PrEP use will lead to a decrease in condom use and increase in STI, the high costs of PrEP and ethical issues regarding prescribing antiretroviral medication to healthy individuals. No preference for a daily or event-driven regimen was detected. Most participants deemed the following groups to be eligible for PrEP: MSM who regularly get post-exposure prophylaxis, who never used condoms with casual partners and with an HIV-positive partner with a detectable viral load. Over half of the participants indicated that PrEP users should partly (54.1%) or fully (35.4%) pay the costs of PrEP.
Conclusion: In 2015, PrEP acceptability was only moderate among Dutch STI professionals and HIV specialists, which is far from an optimal setting. Addressing barriers to PrEP acceptability in educational programmes for various types of healthcare providers is needed to successfully implement PrEP.