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Barriers to PrEP
According to the EIN researchers, physicians perceived many barriers to the use of and access to PrEP. In decreasing order of importance, here are the barriers mentioned by respondents:
- the possible development of drug-resistant HIV should the patient become infected
- giving otherwise-healthy people "a toxic drug"
- insufficient evidence for the effectiveness of PrEP in the real world
- the time-consuming nature of caring for patients on PrEP
Further commenting on perceived barriers, physicians made statements such as the following:
- "Bigger bang for the buck is getting all the HIV-positive patients on HAART and keeping them adherent"
- "PrEP needs to be [provided by family doctors]"
- "I have offered PrEP to partners of HIV-positive patients and they have all declined"
- "The patients most at risk [for HIV and for whom PrEP would be appropriate] don't come into care"
The researchers behind the EIN survey analysed the responses of doctors who had provided PrEP and compared them to responses of doctors who had not provided PrEP but stated that they were willing to do so in the future. The researchers found that doctors who provided PrEP were more willing to do the following:
- prescribe PrEP to men who have sex with men (MSM) regardless of their risks for acquiring HIV
- prescribe PrEP to MSM or heterosexuals with an HIV-positive partner who is taking HAART
An analysis of the geographic distribution of participants from the U.S. was done by researchers. Overall, there was no significant difference in locations of physicians who would or would not provide PrEP.
Despite CDC Guidance
The U.S. Centers for Disease Control and Prevention (CDC) provides guidance and context for health care providers who are interested in the use of PrEP as part of a program to help prevent new HIV infections. However, despite the CDC's documents, the EIN researchers stated that "great variability exists in the real world practice of PrEP suggesting unawareness of, disagreement with or ambiguity of CDC guidance."
According to the EIN researchers, doctors displayed a "modest level of skepticism about the effectiveness of [PrEP in the real world]." Taking into account these and other concerns that the doctors raised when answering the survey, the EIN researchers stated that these concerns "may not be abated with increased [healthcare] provider education as has been recommended by previous studies ...." The researchers stated that a combination of the following might help to relieve the concern that some infectious disease specialists have about PrEP:
- completion of the extension phases of PrEP trials
- future studies of real-world implementation of PrEP
- an increase in the collective experiences of these specialists with PrEP
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