Context and Barriers to the Prescription of Nonoccupational Postexposure Prophylaxis Among HIV Medical Care Providers: National Internet-Based Observational Study in China

• Published in: JMIR public health and surveillance Vol. 7; no. 3; p. e24234
• Main Authors: Ding, Haibo, Ye, Zehao, Tang, Weiming, Huang, Xiaojie, Wang, Hui, Cui, Sitong, Jiang, Yongjun, Geng, Wenqing, Xu, Junjie, Shang, Hong
• Format: Journal Article
• Language: English
• Published: Canada JMIR Publications 11.03.2021
• Subjects: Acquired immune deficiency syndrome; Adult; Age; AIDS; China; Demographics; Developing countries; Disease prevention; Drug resistance; Epidemics; Female; Health care; Health Knowledge, Attitudes, Practice; Health Personnel - psychology; Health Personnel - statistics & numerical data; Health Services Accessibility; Health surveillance; HIV; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Infectious diseases; Internet; LDCs; Male; Medical personnel; Middle Aged; Observational studies; Original Paper; Pilot projects; Post-Exposure Prophylaxis - statistics & numerical data; Prescriptions; Prescriptions - statistics & numerical data; Prophylaxis; Public health; Questionnaires; Risk taking; Surveys and Questionnaires; Variables; China; key populations; nonoccupational postexposure prophylaxis (nPEP); WeChat; barrier; China; HIV medical care providers; training; prophylaxis; social media; internet
• ISSN: 2369-2960; 2369-2960
• DOI: 10.2196/24234

Nonoccupational postexposure prophylaxis (nPEP) is an effective HIV biomedical prevention strategy. The research and use of nPEP are mainly concentrated in the developed world, while little is known about the knowledge, attitudes, and practices of nPEP among HIV medical care providers in developing countries. We aimed to assess the nPEP knowledge and prescribing practice among HIV medical care providers in mainland China. HIV medical care providers were recruited in China during May and June 2019 through an online survey regarding nPEP-related knowledge, attitudes, and clinical prescription experiences. Multivariable logistic regression was performed to identify factors associated with prescribing nPEP among HIV medical care providers. A total of 777 eligible participants participated in this study from 133 cities in 31 provinces in China. Of the participants, 60.2% (468/777) were unfamiliar with nPEP and only 53.3% (414/777) of participants ever prescribed nPEP. HIV care providers who worked in a specialized infectious disease hospital (vs general hospital, adjusted odds ratio [aOR] 2.49; 95% CI 1.85-3.37), had practiced for 6-10 years (vs 5 or fewer years, aOR 3.28; 95% CI 2.23-4.80), had practiced for 11 years or more (vs 5 or fewer years, aOR 3.75; 95% CI 2.59-5.45), and had previously prescribed occupational PEP (oPEP, aOR 4.90; 95% CI 3.29-7.29) had a significantly positive association with prescribing nPEP. However, unfamiliarity with nPEP (aOR 0.08; 95% CI 0.05-0.11), believing nPEP may promote HIV high-risk behavior (aOR 0.53; 95% CI 0.36-0.77) or result in HIV drug resistance (aOR 0.53; 95% CI 0.36-0.77) among key populations, and self-reported having no written oPEP guideline in place (aOR 0.53; 95% CI 0.35-0.79) were negatively associated with nPEP prescription behavior. HIV medical care providers have insufficient nPEP knowledge and an inadequate proportion of prescribing, which may impede the scale-up of nPEP services to curb HIV acquisition. The implementation of tailored nPEP training or retraining to HIV medical care providers would improve this situation.