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Based on the results they have received, the EIN researchers stated that their findings underscore the need for studies that can achieve several outcomes, including the following:
- address the possibility that some PrEP users may engage in intensified risk behaviour and perhaps inadvertently undermine the effectiveness of PrEP. This type of reaction is called "risk compensation" and some physicians were concerned about it.
- the development of simple and accurate ways for assessing adherence
- effects of the "long-term consequences of PrEP on HIV-negative persons"
- approaches to risk-reduction and adherence counselling that are not costly or time consuming
- "novel approaches to improving PrEP cost effectiveness"
In 2012, researchers in Canada led by Dr. Darrell Tan surveyed a range of healthcare providers -- family physicians, infectious disease specialists, internal medicine specialists and public health nurses -- about PrEP.
Fifty-six participants completed their surveys. Nearly 57% identified themselves as HIV specialists and 51% felt "very familiar" with PrEP.
The Canadian survey found that nearly 43% of participants were willing to prescribe PrEP, while 52% stated that they were "unsure" about prescribing it, and 5% stated that they were not willing to do so.
Factors linked to a willingness to prescribe PrEP in Canada were as follows:
- "being a self-described HIV expert"
- being highly familiar with PrEP
- having patients who requested PrEP
The Canadian study also found that doctors had similar concerns to participants in the larger EIN study, such as the following:
- effectiveness of PrEP in the real world
- potential for the development of drug-resistant HIV should patients become infected while taking PrEP
- possible side effects
- cost of PrEP for patients
Although smaller than the EIN study, the Canadian study's findings are very likely robust, as they are similar to those of the larger study. Moreover, the Canadian study surveyed a broader range of healthcare providers.
Like its American counterpart, the Canadian study called for further research on PrEP in the real world, continuing medical education and clinical support for doctors. Also, both studies found that there are barriers to implementing PrEP and see further research as a way to help physicians get the data they need to prescribe PrEP with confidence.
Based on the data gleaned from the U.S. and Canadian studies, it seems that until the concerns of healthcare providers can be addressed, PrEP's use in the real world, at least in North America, may remain limited.
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