Two North American Surveys Engage Doctors About Their Attitudes Towards PrEP

Educational efforts play an essential role in helping to inform people about options for preventing the spread of sexually transmitted infections (STIs), including HIV. Information about STIs themselves -- signs, symptoms, the damage that they can cause, treatment options -- as well as regular screening for these infections and the correct and consistent use of condoms can all be helpful.

In the case of HIV, some clinical trials have found that taking a combination of anti-HIV drugs prior to possible exposure to the virus can reduce the risk of becoming infected. This approach is called Pre-Exposure Prophylaxis (PrEP). Also, in cases where someone is not taking PrEP and may have been exposed to HIV, taking a combination of anti-HIV drugs within 72 hours of exposure every day for 28 consecutive days can greatly reduce the risk of subsequently developing HIV infection. This approach is called Post-Exposure Prophylaxis (PEP).

The Infectious Diseases Society of America (IDSA) has an Emerging Infections Network (EIN). This group consists of infectious disease specialists who currently treat patients experiencing different infections. In the summer of 2013, the EIN surveyed doctors in Canada and the U.S. about their attitudes toward PrEP, how it was prescribed and perceived barriers to its use. In the U.S., the Food and Drug Administration (FDA) has approved the use of a combination of two anti-HIV drugs -- tenofovir + FTC, sold as a fixed-dose combination pill called Truvada -- for use in PrEP.

Researchers analysed responses to the EIN survey from 573 infectious disease specialists. Although a majority of specialists supported the use of PrEP, only 9% had prescribed it. Practices related to the prescription of PrEP and monitoring of patients on PrEP varied considerably. Clinicians reported many barriers to the use of PrEP outside of the well-resourced and controlled setting of a clinical trial.

In another study, Canadian researchers, led by infectious disease specialist Darrell Tan, M.D., Ph.D., surveyed a broader range of physicians in Canada about PrEP than the EIN. Their preliminary findings are somewhat similar to the results of the EIN survey.

Study Details

In the EIN survey, out of the 1,175 infectious disease specialists who were surveyed, 573 (nearly 50%) responded. The physicians were distributed across the U.S. and 35% of respondents were from Canada (the geographic distribution within Canada was not provided).

Results

In general, doctors who responded to the EIN survey about PrEP were more likely to be highly experienced clinicians compared to non-responders. The EIN has found this to be usually the case with respondents to its surveys. Please note that percentages do not add up to 100 because of rounding or in some cases because participants chose to respond to questions with more than one answer.

For and Against PrEP

A majority of doctors (74%) supported the prescription of PrEP. However, only 9% of doctors had actually prescribed PrEP. Here are some of the reasons that doctors disclosed about not prescribing PrEP:

• 77% worried about the possibility that some patients might not take the drug every day exactly as directed. Missing doses could lead to less-than-ideal levels of medicine in the body and could allow HIV infection to take hold. With less-than-ideal levels of PrEP in the body, it is possible that strains of HIV with the ability to partially resist therapy could emerge.
• 57% were concerned about the cost of PrEP and whether or not their patients would be reimbursed.
• 53% did not want to use "potentially toxic drugs in healthy persons."
• 53% did not feel that there was sufficiently robust evidence for PrEP's effectiveness in the everyday world outside of a clinical trial.

Additional reasons for not prescribing PrEP advanced by some doctors included the following (no percentages were provided):

• "Efficacy is limited and creates a false sense of security"
• "If they won't use condoms, they won't use pills"