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

Lamônica, Juliana de Souza; Magno, Laio; Santos, Julia Elen Jesus da Silva; Dourado, Ines; Santos, Adriano Maia dos; Pereira, Marcos

doi:10.1590/0102-311XEN121322

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ARTIGO • Cad. Saúde Pública 39 (Suppl 1) • 2023 • https://doi.org/10.1590/0102-311XEN121322 copy

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

Disposição para oferta de PrEP por profissionais de saúde de serviços especializados em HIV/aids no Nordeste do Brasil

Resistencia de los profesionales de la salud de los servicios especializados en VIH/SIDA a indicar la PrEP en el Nordeste de Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Pre-Exposure Prophylaxis; Attitude of Health Personnel; Knowledge; HIV

Characteristics	n	%	95%CI
Sociodemographic
Gender
Male	55	21.8	17.1-27.3
Female	197	78.2	72.6-82.0
Age (years)
≤ 35	46	18.2	13.9-23.5
≥ 36 ≤ 50	137	54.4	48.1-60.4
> 50	69	27.4	22.2-33.2
Educational level *
High school	39	15.5	11.5-20.5
Higher education	50	19.9	15.4-25.6
Graduate studies	162	64.6	58.1-69.9
Training and work
Professional category
Nurse	65	25.7	20.7-31.5
Physician	30	11.9	8.4-16.5
Other professionals	157	62.4	56.1-68.0
HIV/AIDS specialty
Yes	59	23.4	18.5- 29.0
No	193	76.6	70.9-81.4
Years of training
< 10	65	25.8	20.7-31.5
≥ 10	187	74.2	68.4-79.2
Period spent working in SCS (years)
< 14	185	73.4	67.5-78.5
≥ 14	67	26.6	21.4-32.4
Type of employment
Temporary	85	33.7	28.1-39.8
Tenure	167	66.3	60.1-71.8
Previous knowledge regarding PrEP
Yes	242	96.0	92.7-97.8
No	10	4.0	2.1-7.2
Unwillingness to prescribe PrEP
Yes	215	84.8	80.3-89.1
No	37	15.2	10.8-19.6
How did you come to know about PrEP **
Permanent education/Training actions	149	63.7	57.2-69.6
Via media (TV, radio, etc.)	12	5.1	2.9-8.8
Internet or social networks	9	3.9	2.0- 7.2
Through coworkers	37	15.8	11.6-21.0
Other	27	11.5	8.0-16.3
Location of the SCS in the state capital
Yes	166	65.9	59.7-71.4
No	86	34.1	28.5-40.0
Service offers PrEP
Yes	84	32.9	27.3-39.0
No	168	67.1	60.9-72.6
Knowledge of PNSI-LGBT
No	118	46.9	40.7-53.0
Yes	134	53.1	46.9-59.2
Indicate HIV self-test for the key gay/MSM population
Yes	53	21.7	16.9-27.3
No	191	78.3	72.6-83.0
Indicate PEP for HIV prevention ***
Yes	154	61.1	54.9-66.9
No	98	38.9	33.0-45.0
Continuing education regarding PrEP
Public network professionals are trained ^#
Yes	66	26.4	21.2-32.2
No	184	73.6	67.7-78.7
Promote experience with more experienced professionals
Yes	88	34.9	29.2-41.0
No	164	65.1	58.9-70.7
Promote training and courses
Yes	168	66.7	60.5-72.2
No	84	33.3	27.7-39.4

Characteristics	Unwillingness to indicate PrEP (%)		Bivariate analysis
Characteristics	No (n = 37)	Yes (n = 215)	_crude OR	95%CI	p-value
Sociodemographic
Gender
Male	7.3	92.7	1.0
Female	16.8	83.2	2.6	0.9-7.5	0.089
Age (years)
≤ 35	17.4	82.6	1.0
≥ 36 ≤ 50	15.3	84.7	0.7	0.2-1.5	0.194
> 50	11.6	88.41	0.3	0.2-1.8	0.382
Educational level
High school	30.8	69.2	1.0
Higher education	16.0	84.0	0.4	0.1-1.1	0.194
Graduate studies	10.5	89.5	0.3	0.1-0.8	0.018
Training and work
Prescriber
Other	9.5	90.5	1.0
Nurses and physicians	17.8	82.2	0.4	0.2-1.0	0.074
HIV/AIDS specialty
Yes	8.5	91.5	1.0
No	16.6	83.4	2.1	0.8-5.8	0.131
Years of training
< 10	13.9	86.1	1.0
≥ 10	16.9	83.1	1.1	0.8-1.7	0.554
Period spent working in SCS (years)
< 14	10.5	89.5	1.0
≥ 14	16.2	83.8	1.7	0.7-4.0	0.257
Type of employment
Temporary	14.4	85.6	1.0
Tenure	15.3	84.7	1.1	0.5-2.2	0.845
Location of the SCS in the state capital
No	13.2	86.8	1.0
Yes	17.4	82.6	1.4	0.7-2.8	0.374
Service offers PrEP
Yes	9.6	90.4	1.0
No	17.2	82.8	1.4	0.9-2.1	0.118
Knowledge of PNSI-LGBT
No	12.7	87.3	1.0
Yes	16.9	83.1	1.2	0.8-1.7	0.342
Indicate HIV self-test for the key gay/MSM population
Yes	5.7	94.3	1.0
No	17.1	82.9	5.7	2.2-14.3	0.000
Indicate PEP for HIV prevention
Yes	11.7	88.3	1.0
No	25.5	74.5	1.6	1.1-2.3	0.013
Continuing education regarding PrEP
Public network professionals are trained
Yes	13.6	86.4	1.0
No	15.2	84.8	1.06	0.7-1.6	0.756
Promote experience with more experienced professionals
Yes	9.1	90.9	1.0
No	17.7	82.3	1.5	1.0-2.2	0.071
Promote training and courses
Yes	11.9	78.1	1.0
No	16.1	83.9	1.1	0.9-1.3	0.380

Characteristics	_adjusted OR	95%CI	p-value
Sociodemographic
Gender
Male	1.0
Female	2.5	0.7-8.8	0.158
Age (years)
≤ 35	1.0
≥ 36 ≤ 50	0.8	0.3-2.3	0.675
> 50	0.6	0.1-1.6	0.210
Educational level
High school	1.0
Higher education	0.5	0.1-1.4	0.183
Graduate studies	0.3	0.1-0.8	0.017
Training and work
Prescriber
Other	1.0
Nurses and physicians	0.8	0.3-1.9	0.558
HIV/AIDS specialty
Yes	1.0
No	1.4	0.5-4.4	0.521
Location of the SCS in the state capital
No	1.0
Yes	3.9	1.4-10.2	0.007
Service offers PrEP
Yes	1.0
No	1.7	1.1-2.8	0.035
Indicate HIV self-test for the key gay/MSM population
Yes	1.0
No	5.4	1.3-22.4	0.020
Indicate PEP for HIV prevention
Yes	1.0
No	2.0	1.3-3.1	0.002
Continuing education regarding PrEP
Promote experience with more experienced professionals
Yes	1.0
No	1.8	1.1-3.8	0.014
Promote training and courses
Yes	1.0
No	1.3	1.1-1.8	0.031

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[1] Correspondence
M. Pereira Instituto de Saúde Coletiva, Universidade Federal da Bahia. Rua Basílio da Gama s/n, Salvador, BA 40110-040, Brasil. pereira.santosm@yahoo.com