PrEP in Italy: The time may be ripe but who's paying the bill? A nationwide survey on physicians' attitudes towards using antiretrovirals to prevent HIV infection

Abstract

Several studies have demonstrated the efficacy of the oral pre-exposure prophylaxis (PrEP) with tenofovir (with or without emtricitabine) on preventing HIV-negative partners of HIV infected patients to become infected through sexual contacts. PrEP is already available in the United States and now is approved by European Medicine Agency. In this setting we would like to gauge physicians’ knowledge, acquaintance with and attitude to include PrEP in their clinical practice. A cross sectional survey was conducted among Italian physicians expert on antiretroviral therapy. Out of 146 physicians, 35% of participants declared to be familiar with PrEP but only 46% of them believed that, currently, there are not enough reasons to make it available in Italy. 51% of physicians have already been attracted to prescribe it and 63.4% have been openly asked about PrEP. The main concerns noticed were: the risk of acquire other sexual transmitted diseases (STDs) (70% of physicians feared that PrEP could favor STDs spread), the potential harmful of PrEP if not adequately implemented and, especially the risk of possible side effects if not properly used. Nevertheless, 55.9% of participants believed that Health Authorities face an ethical obligation to make PrEP available as part of the strategies to protect from HIV transmission and half of the respondents asked for further researches to better define the role for PrEP. Attitudes regarding PrEP impact on Italian National Health Organization were also very interesting: 57.5% of participants did not believe that investing in PrEP would be an appropriate use of healthcare resources, while 70.6% affirmed that PrEP’s financial coverage should not be funded by the Italian National System of Health (SSN). This survey showed a high awareness of PrEP potential among Italian physicians coupled with a great deal of skepticism about how and if implementing it in clinical practice.

Knowledge, Attitudes and Practices Regarding Pre-Exposure Prophylaxis (PrEP) in a Sample of Italian Men Who Have SEX with MEN (MSM)

“…These findings are consistent with the results of an Italian study, which showed that, despite 98% of specialized doctors were aware of PrEP, only 14% of them had previously suggested or prescribed PrEP to their patients [ 15 ]. Another Italian study showed that, among physicians expert in antiretroviral therapy, almost 50% of them believed that there are insufficient reasons to make PrEP available in Italy [ 38 ]. However, PrEP efficacy and safety have been confirmed by a steadily growing body of evidence [ 5 , 6 , 39 , 40 ].…”

“…In the third section, knowledge, attitudes and practices regarding PrEP were investigated (items [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. This part of the questionnaire was preceded by a brief definition of PrEP, in order to establish a common ground for each respondent in answering these questions, hence increasing results comparability.…”

Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians

“…Data on PrEP knowledge, though not further assessed, are consistent with previous results among Italian HIV specialists [ 15 ]. Among patients, discussion with their HIV physician was reported by 15%, though we excluded this item from the MLR analysis as in Italy we had observed conflicting results regarding attitudes towards PrEP prescription among HIV physicians [ 15 , 16 ].…”

Sexually Transmitted Infections in the PReP Era. Are Family Doctors Ready to Give Advice?

“…In addition, one study used a clinical case to illustratethe use of PrEP. Another study by Di Biagio et al [18] was conducted in Italy, a European country in which the use of PrEP based on tenofovir and emtricitabine has not yet been approved, although in Europe, it already has the approval of the European Medicine Agency. In this study, the responses to a 21-item survey conducted among physicians at Italian centres that treat HIV patients, was analysed.…”