title: Australian prescribers' perspectives on ART initiation in the era of "treatment as prevention".
abstract: This study explores Australian prescribers' attitudes towards Treatment as Prevention (TasP) and their practices around initiating combination antiretroviral treatment (cART) for HIV. A brief online survey was conducted nationally amongst antiretroviral treatment (ART) prescribers in Australia. The sample broadly represented ART prescribers in Australia (N = 108), with 40.7% general practitioners (GPs), 25.9% sexual health clinic-based physicians and 21.3% hospital-based infectious diseases physicians. About 60% of respondents had been treating HIV-positive patients for more than 10 years. Respondents estimated that about 70-80% of all their HIV-positive patients were receiving ART. Over half of the prescribers agreed very strongly that their primary concern in recommending cART initiation was clinical benefit to individual patients rather than any population benefit. A majority of the prescribers (68.5%) strongly endorsed cART initiation before CD4+ T-cell count drops below 350 cells/mm(3), and a further 22.2% strongly endorsed cART initiation before CD4+ T-cell count drops below 500 cells/mm(3). Regarding the optimal timing of cART initiation, this study shows that prescribers in Australia in 2012 focus primarily on the benefits for their individual patients. Prescribers may need more convincing evidence of individual health benefits or increased knowledge about the population health benefits for a TasP approach to be effective in Australia.
authors: a National Centre in HIV Social Research , University of New South Wales , Sydney , Australia.
authors: Limin
authors: L
authors: Mao
authors: John
authors: J
authors: de Wit
authors: Philippe
authors: P
authors: Adam
authors: Jeffrey J
authors: JJ
authors: Post
authors: Levinia
authors: L
authors: Crooks
authors: Michael R
authors: MR
authors: Kidd
authors: Sean
authors: S
authors: Slavin
authors: Susan
authors: S
authors: Kippax
authors: Edwina
authors: E
authors: Wright
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001291:Attitude of Health Personnel; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011788:Quality of Life
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers