Unwillingness to prescribe PrEP by health care professionals of specialized HIV/AIDS services in Northeastern Brazil

This study aimed to analyze factors associated with the unwillingness to prescribe pre-exposure prophylaxis (PrEP) by health care professionals of specialized HIV/AIDS services. This is a cross-sectional study with 252 health care professionals in 29 specialized care services (SCSs) in HIV/AIDS in 21 municipalities in the state of Bahia, Brazil. The inclusion criterion was that the professional had worked for at least six months in the service. Sociodemographic, occupational, and behavioral data were collected using a questionnaire. Logistic regression was performed with an estimation of crude and adjusted odds ratio (OR) and respective 95% confidence intervals (95%CI). The unwillingness to prescribe PrEP was 15.2% (95%CI: 10.8-19.6). The factors associated with unwillingness to prescribe PrEP were non-prescription of HIV self-tests for key populations (adjustedOR = 5.4; 95%CI: 1.3-22.4) nor post-exposure prophylaxis (adjustedOR = 2.00; 95%CI: 1.3-3.1), location of the SCS in the state capital (adjustedOR = 3.9; 95%CI: 1.4-10.2), and SCSs without PrEP offer (adjustedOR = 1.7; 95%CI: 1.1-2.8); professionals who have not reported the need to conduct training and courses (adjustedOR = 1.3; 95%CI: 1.1-1.8), or training with more experienced professionals (adjustedOR = 1.8; 95%CI: 1.1-3.8), was associated with a lower proportion of unwillingness to prescribe PrEP. Our results indicate that health care professionals’ contextual, organizational, and training factors can contribute to PrEP indication. We suggest expanding ongoing training in combined HIV prevention among health care professionals and increasing the availability of PrEP in health services.

本研究旨在分析巴西巴伊亚州21个市的29家艾滋病专科诊疗服务机构（specialized care services, SCSs）的医护人员不愿开具暴露前预防用药（pre-exposure prophylaxis, PrEP）的相关影响因素。本研究为横断面研究，共纳入252名医护人员，纳入标准为该医护人员在对应机构工作时长至少6个月。研究采用问卷收集研究对象的社会人口学、职业及行为学相关数据，并开展Logistic回归分析，估算粗比值比与校正后比值比（odds ratio, OR）及其对应的95%置信区间（95% confidence intervals, 95%CI）。本研究中，医护人员不愿开具PrEP的比例为15.2%（95%CI: 10.8-19.6）。与不愿开具PrEP相关的因素包括：未为关键人群开具艾滋病自我检测试剂（校正OR=5.4; 95%CI: 1.3-22.4）、未开具暴露后预防用药（校正OR=2.00; 95%CI: 1.3-3.1）、专科诊疗服务机构位于州首府（校正OR=3.9; 95%CI: 1.4-10.2）以及未提供PrEP的专科诊疗服务机构（校正OR=1.7; 95%CI: 1.1-2.8）；而未报告需要开展相关培训课程（校正OR=1.3; 95%CI: 1.1-1.8）或接受过资深专业人员带教培训（校正OR=1.8; 95%CI: 1.1-3.8）的医护人员，其不愿开具PrEP的比例更低。本研究结果表明，医护人员的情境、组织及培训相关因素会影响PrEP的开具决策。我们建议进一步拓展针对医护人员的艾滋病综合预防相关培训，并提升医疗机构中PrEP的可及性。