title: Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England.
abstract: BACKGROUND
  Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited.
  
  
  METHODS
  Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices.
  
  
  RESULTS
  Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01-1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98-11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06-1.34), whereas female gender (aOR 0.26, 95% CI 0.10-0.71) was associated with having not prescribed PrEP.
  
  
  CONCLUSIONS
  These findings suggest many clinicians have shifted towards routinely recommending early ART, but not PrEP, so interventions to facilitate PrEP provision are needed.
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America; The Fenway Institute, Boston, Massachusetts, United States of America.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Krakower
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Mitty
authors.affiliation: Brown University School of Public Health, Providence, Rhode Island, United States of America.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.affiliation: New York University, New York, New York, United States of America.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Maloney
authors.affiliation: New England AIDS Education and Training Center, Boston, Massachusetts, United States of America.
authors.forename: Donna
authors.initials: D
authors.lastname: Gallagher
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America; The Fenway Institute, Boston, Massachusetts, United States of America; Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003469:Culture; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009511:New England; D058007:Physicians, Primary Care / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents