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Clin Infect Dis. 2016 Jan 1;62(1):99-105. doi: 10.1093/cid/civ736. Epub 2015 Sep 18.

Diffusion of Newer HIV Prevention Innovations: Variable Practices of Frontline Infectious Diseases Physicians.

Author information

1
Division of Infectious Diseases, Beth Israel Deaconess Medical Center.
2
The Fenway Institute, Fenway Health, Boston, Massachusetts.
3
Departments of Internal Medicine.
4
Epidemiology, University of Iowa Carver College of Medicine, Iowa City.

Abstract

BACKGROUND:

US Public Health Service guidelines recommend early initiation of antiretroviral treatment (ART) for human immunodeficiency virus infection (HIV)-infected patients and preexposure prophylaxis (PrEP) as a prevention option for persons at risk for HIV acquisition. Before issuance of these guidelines, few clinicians reported prescribing early ART or PrEP.

METHODS:

The Emerging Infections Network, a national network of infectious diseases physicians in the United States and Canada, was surveyed in September 2014 to assess practices of adult HIV-care providers with early ART, PrEP, and other guideline-recommended HIV prevention methods.

RESULTS:

Almost half of the 1191 active members invited (48.1%) participated; 415 (72.4%) were HIV-care providers. Most providers (86.5%) indicated that they typically recommended ART initiation at diagnosis, irrespective of CD4(+) cell count. However, for patients with a CD4(+) cell count >500/µL, clinicians would defer ART if patients did not feel ready to initiate ART (94.7%) or had uncontrolled substance abuse (66.0%). Many providers had counseled HIV-infected patients about PrEP for partners (59.0%) or offered visits for partners to discuss PrEP (40.7%), and 31.8% had prescribed PrEP. Clinicians who deferred ART were less likely to endorse and engage in aspects of PrEP provision.

CONCLUSIONS:

Concordant with guidelines, most infectious diseases physicians recommend early ART, and many have experience with aspects of PrEP provision, suggesting recent evolution of clinician practices. Providers who defer ART are also cautious about PrEP. Interventions that help physicians motivate patients to initiate ART and identify missed opportunities to provide PrEP could enhance HIV prevention.

KEYWORDS:

HIV prevention; early antiretroviral treatment; healthcare provider; preexposure prophylaxis

PMID:
26385993
PMCID:
PMC4678105
DOI:
10.1093/cid/civ736
[Indexed for MEDLINE]
Free PMC Article

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