Attitudes and Perceived Barriers to Routine HIV Screening and Provision and Linkage of Postexposure Prophylaxis and Pre-Exposure Prophylaxis Among Graduate Medical Trainees

Abstract

New York City is the metropolitan area in the United States with the highest number of new HIV diagnoses nationwide. The End-The-Epidemic (EtE) initiative calls for identifying persons with HIV who remain undiagnosed, linking and retaining persons living with HIV to maximize viral suppression, and facilitate access to pre-exposure prophylaxis (PrEP) for patients at increased risk of HIV. HIV screening represents the first step to both the primary and secondary HIV prevention cascades. We conducted an online, anonymous, cross-sectional survey of residents at all stages of training within four residency programs at one institution in Northern Manhattan between August 2017 and August 2018. All internal medicine, emergency medicine, obstetrics and gynecology trainees, and pediatrics were invited to complete the survey via email. Of 298 eligible trainees, 142 (48%) completed the survey. Most trainees were aware of the HIV testing law and agreed that HIV testing was their responsibility, but few successfully screened most of their patients. Most trainees were not knowledgeable about non-occupational post-exposure prophylaxis (nPEP) or PrEP, but felt that it was important to provide these services across settings. Barriers to HIV, nPEP, and PrEP varied across specialties. Ending the HIV epidemic will require efforts across clinical specialties. In this survey from an EtE jurisdiction, most trainees felt that it is important to provide HIV prevention services in most settings; however, their knowledge and comfort with HIV prevention services other than testing were low. Barriers varied across specialties, and developing specialty-specific materials for trainees may be beneficial.

Keywords: HIV prevention; HIV testing; PEP; PrEP; medical resident; medical trainee.

FIG. 1.

Knowledge, attitudes, and beliefs about routine HIV screening among trainees (n = 142) by area of training. The responses were in agreement with statements about their attitudes and efficacy of routine screening using 5-point Likert-type scales (1-strongly disagree; 5-strongly agree). HIV, human immunodeficiency virus. Color images available online.

FIG. 2.

Self-reported barriers to routine HIV testing among trainees by area of training. Individuals were asked to identify their top 3 barriers to routine screening for HIV (n = 9), which were organized into three domains. Percent of individuals choosing any individual barrier were reported. HIV, human immunodeficiency virus. Color images available online.

FIG. 3.

Knowledge, attitudes, and beliefs about the provision of postexposure and PrEP among trainees by area of training. Responses were in agreement with statements about their attitudes and efficacy of routine screening using 5-point Likert-type scales (1-strongly disagree; 5-strongly agree or 1-not at all; 5-extremely). Question stems were shortened for display purposes. PEP, postexposure prophylaxis; PrEP, pre-exposure prophylaxis; NYCDOHMH, New York City Department of Health and Mental Hygiene. Color images available online.

FIG. 4.

Attitudes about PrEP linkage among trainees by area of training. The responses were in agreement with statements about their attitudes and efficacy of PrEP linkage to care using 5-point Likert-type scales (1-strongly disagree; 5-strongly agree or 1-not at all; 5-extremely). PrEP, pre-exposure prophylaxis. Color images available online.

FIG. 5.

Self-reported barriers to (A) PEP and (B) PrEP provision among trainees by area of training. Individuals were asked to identify their top 3 barriers to routine screening for HIV (n = 10), which were organized into four domains. Percent of individuals choosing any individual barrier were reported. PEP, postexposure prophylaxis; PrEP, pre-exposure prophylaxis. Color images available online.