Knowledge, attitudes, and beliefs about HIV pre-exposure prophylaxis among US Air Force Health Care Providers

Abstract

Providers are central to effective implementation of HIV pre-exposure prophylaxis (PrEP). Primary care providers (PCP) and infectious disease physicians (ID) in the US Air Force (USAF) participated in a cross-sectional survey regarding knowledge, attitudes, and beliefs toward HIV PrEP. Characteristics associated with PrEP knowledge were assessed in univariate and multivariate analyses.Among 403 (40% of 1015 providers) participants, 9% (PCP 383, ID 20) ever prescribed PrEP. In univariate analysis, years in practice, number of HIV-infected patients treated in the past 12 months, past prescription of antiretrovirals for HIV prevention, frequency of prescribing PrEP in the past 12 months, and ever being questioned by a patient about PrEP were associated with PrEP knowledge (P < 0.05). In multivariate analysis, providers who had ever prescribed antiretrovirals to prevent HIV (AOR: 2.37, 95% CI: 1.27-4.42) had greater odds of high PrEP knowledge. Despite concerns about medication side effects (overall 67%: PCP 68%, ID 85%) and prescribing PrEP without clear evidence (overall 60%: PCP 65%, ID 62%), 64% (PCP 65%, ID 85%) of participants indicated PrEP should be offered in the Military Health System and 68% (PCP 70%, ID 100%) disagreed with the statement that their patient population was not at risk for HIV infection.Successful PrEP implementation in the USAF will require continued education and training of primary care providers to improve knowledge and mitigate concerns about PrEP.

Figure 1

Geographic distribution of 403 participants’ medical practices. Overseas locations of practice are not included in the figure for 63 providers; these were in Germany, Italy, Estonia, Saudi Arabia, United Arab Emirates, Turkey, Afghanistan, Japan, Korea, and Guam. A star illustrates practice locations for all infectious disease providers in the United States and, overseas, in Germany.

Figure 2

(A) Providers’ beliefs and (B) concerns about HIV pre-exposure prophylaxis. Providers were asked to choose a response (agree, disagree, unsure) to each statement presented on the Y axis. The percent in bars reflects frequency of a response by participants. The proportion of participants who did not respond is indicated in parentheses as a percentage. HIV = human immunodeficiency virus.

Figure 3

(A) Providers’ beliefs about patient populations who should be offered HIV pre-exposure prophylaxis and (B) primary reasons they would prescribe HIV pre-exposure prophylaxis. For each type of patient population (A) or statement (B) shown on the Y axis, providers were asked to respond (A: [1] Yes, regardless of condom use; [2] Yes, but only if NOT using condoms, [3] No; B: scale of 1—Least Likely to 5—Most Likely) whether they would offer PrEP. The percent within bars reflect the frequency of each type of response by participants. The proportion of participants who did not respond is indicated as in parentheses as a percentage. HIV = human immunodeficiency virus, PrEP = pre-exposure prophylaxis.