PrEP KAP. Sexual healthcare providers knowledge of, attitudes to and practice of pre-exposure prophylaxis (PrEP) for HIV prevention

Transcription

1 PrEP KAP Sexual healthcare providers knowledge of, attitudes to and practice of pre-exposure prophylaxis (PrEP) for HIV prevention We would like to understand healthcare providers knowledge of, attitudes to and practice of pre-exposure prophylaxis (PrEP). Pre-exposure prophylaxis is the use of anti-retrovirals BEFORE having sex to reduce the risk of HIV infection. PrEP is not widely available in the UK outside of the PROUD clinical trial. However, if it was to become widely available, it is important to understand healthcare providers views. Please complete the survey as fully and honestly as possible. The survey is anonymous. We do ask for the name of the sexual health clinic that you work at. This is so that we can analyse by regional differences in HIV incidence and prevalence in the analysis. Thank you for taking part. Monica Desai Sheena McCormack Anthony Nardone SCREENING QUESTIONS Having read the information above, do you to participate in this study by completing the questionnaire? You do not need to complete this survey Do you see HIV negative patients at risk of HIV in your clinical practice? You do not need to complete this survey Have you completed this questionnaire previously? You do not need to complete this survey again From which source did you receive this questionnaire? SSHA BHIVA BASHH Clinical lead at your clinic

2 SECTION A: KNOWLEDGE OF PrEP (pre-exposure prophylaxis) In this part of the questionnaire, we want to know about your current knowledge of pre-exposure prophylaxis (PrEP). A1. How would you rate your knowledge of PrEP (pre-exposure prophylaxis)? Never heard of it Low Medium High A2. Have you read the BHIVA/BASHH position statement on PrEP? A3. How familiar are you with the results of the following placebo-controlled studies of PrEP? iprex Never heard of it t very familiar Moderately familiar Very familiar FEM-PREP Never heard of it t very familiar Moderately familiar Very familiar CDC-TDF2 Never heard of it t very familiar Moderately familiar Very familiar Partners PrEP Never heard of it t very familiar Moderately familiar Very familiar VOICE Never heard of it t very familiar Moderately familiar Very familiar A4. Are you aware that there is an ongoing open-label study of PrEP in the UK, called PROUD? A5. Are you involved with the PROUD study in the UK (e.g recruiting, monitoring, study team)? A6. Do you feel that you know enough about PrEP to have an informed discussion with your patients?

3 SECTION B: ATTITUDES TO PrEP In this part of the questionnaire, we want to know about your attitudes to pre-exposure prophylaxis, in particular about the evidence base, prescribing and clinical management, patient safety, prioritization and commissioning and provision. B1. Based on currently available evidence, do you think that PrEP should be available in the UK outside of a clinical trial? In this question, sex is assumed to be anal or vaginal and reporting at least one episode of unprotected sex (without a condom) in the last 90 days. If yes, who should it be available to (please tick all that apply): Men who have sex with men MSM with recurrent acute rectal STIs MSM reporting anal sex All MSM People with multiple partners MSM only All persons Sex workers MSM only All persons Injecting drug users sharing needles HIV uninfected partners in monogamous serodiscordant relationships MSM only All persons HIV uninfected partners in serodiscordant relationships trying to conceive B2. In the case of monogamous serodiscordant couples, which of the following options would you choose to protect the negative partner from HIV infection? Antiretroviral treatment of the positive partner regardless of CD4 count PrEP to the uninfected partner Antiretrovirals to the HIV positive partner and PrEP to the HIV uninfected partner Safer sex counselling only to the uninfected partner Other, please specify

4 EVIDENCE BASE B3. Here are some statements about the evidence base for pre-exposure prophylaxis (PrEP). Please read each statement carefully and place a tick in the box that is closest to your viewpoint. Give only one answer for each row. a) PrEP should be made widely available based on current evidence b) I am concerned that PrEP will not be an effective prevention tool in the real world based on the current evidence dis dis PRESCRIBING AND CLINICAL MANAGEMENT OF PrEP B4. Here are some statements about prescribing and clinical management of preexposure prophylaxis (PrEP). Please read each statement carefully and place a tick in the box that is closest to your viewpoint. Give only one answer for each row. a) I would feel uncomfortable prescribing PrEP without UK specific prescribing guidance b) I do not have time to engage in prevention counselling for PrEP c) I do not have time to perform the monitoring required for PrEP (e.g. adherence, safety monitoring) dis dis

5 PATIENT SAFETY B5. Here are some statements about patient safety and pre-exposure prophylaxis (PrEP). Please read each statement carefully and place a tick in the box that is closest to your viewpoint. Give only one answer for each row. a) Truvada is a safe drug for use as PrEP b) The use of PrEP will result in an increase in sexually transmitted infections c) My patients will be able to adhere to a daily regimen of PrEP d) Use of Truvada as PrEP will have minimal impact on antiretroviral drug resistance in the UK e) There will be support from the gay community and gay press if PrEP is made available f) I am concerned that my patients will be wrongly perceived to be HIV positive by their partners if they are taking PrEP g) Taking PrEP may put my patients at risk of sexual or physical coercion or violence h) I am worried that my patients will be stigmatised for taking PrEP If yes to h), please note any stigmatising or negative attitudes: Stigmatising or negative views: dis dis

6 PRIORITISATION OF PrEP B6. Here are some statements about prioritisation of pre-exposure prophylaxis (PrEP). Please read each statement carefully and place a tick in the box that is closest to your viewpoint. Give only one answer for each row. a) Access to testing and care for HIV infection will make a bigger difference than PrEP to the UK HIV epidemic b) PrEP will have a greater impact than behavioural interventions in preventing HIV infection c) Funding for PrEP will be at the expense of other prevention methods dis dis COMMISSIONING AND PROVISION OF PrEP B7. Here are some statements about commissioning and provision of pre-exposure prophylaxis (PrEP). Please read each statement carefully and place a tick in the box that is closest to your viewpoint. Give only one answer for each row. a) PrEP should be made available on the NHS to all patients who request it b) PrEP should only be made available on the NHS to target groups at high risk of HIV infection c) PrEP should be available on the NHS with a top-up fee for users d) PrEP should only be available with a private prescription to those patients that request it dis dis

7 SECTION C: PRACTICE OF PrEP In this part of the questionnaire, we want to know about your current usage (advising and prescribing) of pre-exposure prophylaxis (PrEP). C1. Have you been asked by any of your patients about PrEP in the PAST YEAR? Go to question C3 C2. If yes, who has asked you about PrEP in the PAST YEAR? (tick all that apply) Men who have sex with men Person having transactional sex Injecting drug users HIV uninfected partner in serodiscordant relationship HIV uninfected partner in serodiscordant relationship trying to conceive C3. How many times in the PAST YEAR have you prescribed or discussed taking PrEP as a prevention option with a patient? >10

8 SECTION D: POST-EXPOSURE PROPHYLAXIS (PEP) In this part of the questionnaire, we want to know about your knowledge and attitudes to postexposure prophylaxis (PEP), which is given AFTER a potential exposure. Please answer as honestly as possible. D1. Have you ever referred to the UK guidelines for PEP (post-exposure prophylaxis) for sexual exposure? D2. Have you been asked by any of your patients about PEP in the PAST YEAR? D3. How many times in the PAST YEAR have you prescribed or discussed taking PEP as a prevention option with a patient? >10 ATTITUDES TO POST-EXPOSURE PROPHYLAXIS (PEP) D5. Here are some statements about commissioning and provision of post-exposure prophylaxis (PEP). Please read each statement carefully and place a tick in the box that is closest to your viewpoint. Give only one answer for each row. a) PEP should be available to all persons according to UK guidelines for PEPSE on the NHS b) PrEP would be a more effective prevention option than post-exposure prophylaxis (PEP) for patients who use PEP regularly. dis dis

9 D6. Here are some statements about commissioning and provision of post-exposure prophylaxis (PEP). Please read each statement carefully and place a tick in the box that is closest to your viewpoint. Give only one answer for each row. a) PEP should be available on the NHS to all patients who request it b) PEP should only be available on the NHS to target groups at high risk of HIV infection c) PEP should be available on the NHS with a top-up fee for users d) PEP should only be available with a private prescription to those patients that request it dis dis D7. Do you prescribe or recommend antiretrovirals to HIV-uninfected persons to prevent HIV infection? (tick all that apply), after occupational exposure (PEP), after non-occupational exposure (PEPSE), before exposure (PrEP)

10 SECTION E: DEMOGRAPHICS AND WORK HISTORY E1. Are you: Male Female E2. What is your age? E3. What is your profession? Health advisor Research nurse Sexual health nurse Doctor: Consultant SAS grade doctor Trainee Other, please specify E4. How many years have you worked in sexual health? <1 year 1-5 years 6-15 years >15 years E5. Where do you consult the majority of your patients each week? Sexual health clinic Name of clinic Other, please specify E6. How much of your time consulting patients is spent on the following activities (as percentage of working week) % HIV and STI risk reduction % HIV treatment % STI diagnosis and treatment

11 Thank you very much for completing this questionnaire. Please seal the questionnaire in the envelope provided and place it in the survey box at reception or return it to: Monica Desai, HIV/STI Department, Public Health England, 61 Colindale Ave, London, NW9 5EQ Thank you. THIS PROJECT IS RUN BY: Public Health England and the Medical Research Council Contact for any queries: Monica Desai, Public Health England, Useful links: The PROUD study The results of the iprex study were published in the New England Journal of Medicine in December 2010 and the paper is available free online: A summary of the study can be found at: NAM summary of history and trials of PrEP