Attitudes and Knowledge About Human Immunodeficiency Virus Pre-Exposure Prophylaxis Among Brazilian Infectious Disease Physicians

Cerqueira, Natalia B; Vasconcelos, Ricardo; Hojilla, J Carlo; Kallás, Esper G.; Avelino‐Silva, Vivian Iida

doi:10.1089/aid.2019.0281

Cited by 3 publications

(8 citation statements)

References 28 publications

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“…Although awareness was similar in both countries, willingness to prescribe PrEP was higher in Brazil than Mexico, while barriers and concerns were more frequent in Mexico, which may be explained by the different stages of PrEP implementation in both countries. Awareness and willingness to prescribe PrEP (84.6% & 74.2%) were higher than previous studies conducted in LAC in Guatemala City (69% & 87%) and São Paulo, Brazil (75% & 63-69%) [26,27], possibly due to increased information about PrEP over time and PrEP implementation in the Brazilian SUS since December 2017 [13]. Our results offer updated information to inform the Ministry of Health, stakeholders, clinicians and policy makers from Brazil, Mexico and other LAC countries on different stages of PrEP implementation [33].…”

Section: Discussionmentioning

confidence: 55%

“…We used Alchemer ® (Brazil) and SurveyMonkey ® (Mexico) for programming the questionnaire. The survey was designed based on previous studies [21,23,26,27], and consisted of 37 questions in 22 pages. Participants could only answer questions on one page after completing all items on the previous page.…”

Section: Methodsmentioning

confidence: 99%

“…In 2015, in Guatemala, 69% of internal medicine and infectious disease trainees reported awareness of PrEP, and 87% had willingness to prescribe it [26]. In Brazil, a study conducted between Vega-Ramirez et al BMC Health Services Research (2022) 22:532 2016 and 2017 showed that 75% of infectious disease physicians were aware of PrEP, and between 63 and 69% reported willingness to prescribe PrEP for MSM or sex workers with inconsistent condom use [27]. However, such information is not available for Mexico and for Brazil after PrEP implementation in December 2017.…”

Section: Introductionmentioning

confidence: 99%

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Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey

Vega-Ramírez

Torres

Guillen-Diaz

et al. 2022

BMC Health Serv Res

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Background In order to end the HIV epidemic by 2030, combination HIV prevention including pre-exposure prophylaxis (PrEP) should be widely available, especially for the most vulnerable populations. In Latin America and the Caribbean (LAC), only 14 out of 46 countries have access to PrEP. In Brazil and Mexico, PrEP has been provided at no cost through the Public Health System since 2017 and 2021, respectively. Thus, HIV physicians’ perspectives about PrEP and other prevention strategies may differ. This study aimed to compare awareness, knowledge, and attitudes related to PrEP and other prevention strategies among HIV physicians from Brazil and Mexico. Methods Cross-sectional, web-based survey targeting physicians who prescribe antiretrovirals from both countries. Participants answered questions on socio-demographic, medical experience, awareness, knowledge, and attitudes towards PrEP and other HIV prevention strategies. We stratified all variables per country and compared frequencies using Chi-square, Fisher exact, and Wilcoxon-Mann-Whitney tests, as appropriate. Results From January–October 2020, 481 HIV physicians were included: 339(70.5%) from Brazil, 276(57.4%) male, and median age was 43 years (IQR = 36–53). Awareness of PrEP did not differ between Brazil and Mexico (84.6%), while awareness of other prevention strategies, including post-exposure prophylaxis and new PrEP technologies, was higher in Brazil. More Brazilians perceived U=U as completely accurate compared to Mexicans (74.0% vs. 62.0%, P < .001). Willingness to prescribe PrEP was 74.2%, higher among Brazilians (78.2%, P = .01). Overall, participants had concerns about consistent access to PrEP medication and the risk of antiretroviral resistance in case of acute HIV infection or seroconversion. The main barriers reported were assumptions that users could have low PrEP knowledge (62.0%) or limited capacity for adherence (59.0%). Compared to Brazilians, Mexicans reported more concerns and barriers to PrEP prescription (all; P ≤ .05), except for consistent access to PrEP medication and the lack of professionals to prescribe PrEP (both; P ≤ .01). Conclusions Although awareness of PrEP was similar in Brazil and Mexico, differences in knowledge and attitudes may reflect the availability and stage of PrEP implementation in these countries. Strengthening and increasing information on PrEP technologies and other HIV prevention strategies among HIV physicians could improve their comfort to prescribe these strategies and facilitate their scale-up in LAC.

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Section: Discussionmentioning

confidence: 55%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey

Vega-Ramírez

Torres

Guillen-Diaz

et al. 2022

BMC Health Serv Res

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“…Hence, HIV care-experienced physicians could also eventually function as PrEP champions in their clinics since promoting the visibility of successful adopters can accelerate adoption by other practitioners [ 38 ]. Importantly, several studies have reported that PrEP adoption and patient retention in care by primary care providers, HIV specialists, and other HCP remain low in Europe and North America (less than 30%) [ 39 , 40 ], while a recent study in Brazil, reported that 70% of infectious disease doctors had not prescribed PrEP three years after its approval [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interpersonal stigma against MSM and TGW have been also described in other studies as factors hindering PrEP prescription [ 18 ]. One study in Brazil indicated that infectious disease doctors who declared a religion had more frequent concerns about risk compensation and lower willingness to prescribe PrEP to people who reported condomless sex [ 41 ]. Therefore, frank discussions about the importance of avoiding the HCP’s moral values affecting PrEP therapeutic decisions should be central in PrEP training.…”

Section: Discussionmentioning

confidence: 99%

Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study

Martínez-Cajas

Torres-Isasiga

Mueses-Marín

et al. 2022

Implement Sci Commun

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Background Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP. Methods We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks’ domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation. Results We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care. Conclusion Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system.

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Beyond HIV prevention: Assessment of the benefits of pre-exposure prophylaxis for sexual quality of life

Bertevello,

Vasconcelos,

Cerqueira

et al. 2023

Int J STD AIDS

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Background Pre-exposure prophylaxis (PrEP) may favor sexual satisfaction by reducing the fear of HIV and promoting less restrictive sexual practices. These benefits may be even higher among PrEP users with mental health issues. Methods We invited adult PrEP users to answer a questionnaire including demographics, questions on the sexual experience compared to the period before PrEP use, and the Hospital Anxiety and Depression Scale. Factors associated with improvements in the sexual experience were investigated using modified Poisson models. Results We included 221 participants; most were white males. A large percentage of participants reported improvements in quality of sex after PrEP initiation; the composite outcome “PrEP-associated improvement in the quality of sex” was observed in 92 (42%), whereas the outcome “PrEP-associated improvement in the fear of HIV acquisition” was observed in 120 participants (54%). Demographics and depression/anxiety were not significantly associated with the outcomes. Conclusion PrEP has positive effects beyond HIV prevention, improving several aspects of sexual quality of life. These benefits are valid incentives for PrEP use and prescription.

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Attitudes and Knowledge About Human Immunodeficiency Virus Pre-Exposure Prophylaxis Among Brazilian Infectious Disease Physicians

Cited by 3 publications

References 28 publications

Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey

Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: cross-sectional web-based survey

Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study

Beyond HIV prevention: Assessment of the benefits of pre-exposure prophylaxis for sexual quality of life

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