Diffusion of Newer HIV Prevention Innovations: Variable Practices of Frontline Infectious Diseases Physicians

US Public Health Service guidelines recommend early initiation of antiretroviral treatment (ART) for human immunodeficiency virus infection (HIV)-infected patients and preexposure prophylaxis (PrEP) as a prevention option for persons at risk for HIV acquisition. Before issuance of these guidelines, few clinicians reported prescribing early ART or PrEP.

The Emerging Infections Network, a national network of infectious diseases physicians in the United States and Canada, was surveyed in September 2014 to assess practices of adult HIV-care providers with early ART, PrEP, and other guideline-recommended HIV prevention methods.

Almost half of the 1191 active members invited (48.1%) participated; 415 (72.4%) were HIV-care providers. Most providers (86.5%) indicated that they typically recommended ART initiation at diagnosis, irrespective of CD4⁺ cell count. However, for patients with a CD4⁺ cell count >500/µL, clinicians would defer ART if patients did not feel ready to initiate ART (94.7%) or had uncontrolled substance abuse (66.0%). Many providers had counseled HIV-infected patients about PrEP for partners (59.0%) or offered visits for partners to discuss PrEP (40.7%), and 31.8% had prescribed PrEP. Clinicians who deferred ART were less likely to endorse and engage in aspects of PrEP provision.

Concordant with guidelines, most infectious diseases physicians recommend early ART, and many have experience with aspects of PrEP provision, suggesting recent evolution of clinician practices. Providers who defer ART are also cautious about PrEP. Interventions that help physicians motivate patients to initiate ART and identify missed opportunities to provide PrEP could enhance HIV prevention.

Below:  Opinions of human immunodeficiency virus infection (HIV) specialists and experiences regarding provision of preexposure prophylaxis (PrEP) to members of HIV-serodiscordant couples (n = 415). Respondents indicated whether they considered aspects of PrEP provision to be part of their clinical role, including counseling HIV-infected partners about PrEP, offering visits to HIV-uninfected partners to discuss PrEP, and prescribing PrEP. Clinicians also reported on their experiences with these aspects of PrEP provision. Most respondents perceived a duty to engage in aspects of PrEP provision, and many had counseled HIV-infected patients about PrEP, but only 1 in 3 had prescribed PrEP.

Below:  Opinions of human immunodeficiency virus infection (HIV) specialists and perceptions regarding provision of HIV prevention interventions to persons who inject drugs (PWID) (n = 415). Respondents indicated whether or not they agreed that several prevention interventions should be offered routinely to PWID, including sterile syringes, opiate substitution therapy, and preexposure prophylaxis (PrEP). They also reported whether they felt adequately prepared to provide each of these interventions. Many respondents supported provision of preventive interventions to PWID, but few felt prepared to provide these.

Below:  Practices of human immunodeficiency virus infection (HIV) specialists in delivering risk-reduction counseling to HIV-infected patients (n = 415). Respondents reported the percentages of patients with newly diagnosed or established HIV infection to whom they had delivered risk-reduction counseling in the prior month. They delivered counseling to a greater proportion of patients with newly diagnosed infection.

Via: http://ht.ly/SJ6ur Full article at: http://goo.gl/z1LZXi

By: Krakower DS1, Beekmann SE2, Polgreen PM3, Mayer KH1.

• 1Division of Infectious Diseases, Beth Israel Deaconess Medical Center The Fenway Institute, Fenway Health, Boston, Massachusetts.
• 2Departments of Internal Medicine.
• 3Departments of Internal Medicine Epidemiology, University of Iowa Carver College of Medicine, Iowa City.

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