title: HIV medical providers' perceptions of the use of antiretroviral therapy as nonoccupational postexposure prophylaxis in 2 major metropolitan areas.
abstract: BACKGROUND
  In 2005, the Centers for Disease Control and Prevention expanded its recommendation of postexposure prophylaxis (PEP) use in the workplace to include nonoccupational exposures (nPEP). The availability and extensive use of nPEP have not achieved widespread acceptance among health-care providers of high-risk populations, and public health and primary care agencies have been sparse in their implementation of nPEP promotion, protocols, and practices.
  
  
  METHODS
  We conducted a survey of HIV providers (n = 142, response rate = 61%) in Miami-Dade County (Florida) and the District of Columbia that focused on their knowledge, attitudes, beliefs, and practices related to the delivery of nPEP. We then analyzed differences in survey responses by site and by history of prescribing nPEP using bivariate and multivariate logistic regression.
  
  
  RESULTS
  More District of Columbia providers (59.7%) reported ever prescribing nPEP than in Miami (39.5%, P < 0.048). The majority of practices in both cities did not have a written nPEP protocol and rarely or never had patients request nPEP. Multivariable analysis for history of prescribing nPEP was dominated by having patients request nPEP [odds ratio (OR) = 21.53] and the belief that nPEP would lead to antiretroviral resistance (OR = 0.14) and having a written nPEP protocol (OR = 7.49).
  
  
  CONCLUSIONS
  Our findings are consistent with earlier studies showing the underuse of nPEP as a prevention strategy. The significance of having a written nPEP protocol and of patient requests for nPEP speaks to the importance of using targeted strategies to promote widespread awareness of the use of HIV antiretroviral medications as a prevention intervention.
authors.affiliation: *Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida; †Department of Epidemiology and Biostatistics, George Washington University, Washington, D.C.; ‡Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York; §Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; ‖District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, D.C.; and ¶Miami-Dade County Health Department, Office of HIV/AIDS Services, Miami, Florida.
authors.forename: Allan E
authors.initials: AE
authors.lastname: Rodríguez
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Castel
authors.forename: Carrigan L
authors.initials: CL
authors.lastname: Parish
authors.forename: Sarah
authors.initials: S
authors.lastname: Willis
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feaster
authors.forename: Michael
authors.initials: M
authors.lastname: Kharfen
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Cardenas
authors.forename: Kira
authors.initials: K
authors.lastname: Villamizar
authors.forename: Michael
authors.initials: M
authors.lastname: Kolber
authors.forename: Liliana
authors.initials: L
authors.lastname: Vázquez-Rivera
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Metsch
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D004219:District of Columbia; D005260:Female; D005431:Florida; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population
chemical_list: D019380:Anti-HIV Agents