Attitudes and Practices of a Sample of Nova Scotian Physicians for the Implementation of HIV Pre-Exposure Prophylaxis

Introduction: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that requires the ongoing support of physicians to be accessible. Recently, Nova Scotia experienced a 100% increase in HIV diagnoses. The purpose of this study is to explore the relationship between physicians' support of PrEP, knowledge of PrEP, and PrEP prescribing history using the information-motivation-behavioral (IMB) skills model.

Methods: An online survey was distributed to physicians in Nova Scotia, Canada, and eighty physicians participated. Two exploratory factor analyses were conducted with items from the Support of PrEP scale and Knowledge of PrEP scale. A mediation analysis was conducted to assess if knowledge of PrEP mediated the relationship between support of PrEP and whether physicians have prescribed PrEP in the past.

Results: On average, physicians reported strong support for PrEP, and as support for PrEP increased so did knowledge of PrEP. Further, physicians who had prescribed PrEP demonstrated strong knowledge of PrEP and physicians who had not prescribed PrEP reported feeling neutral. The 95% bootstrap confidence interval indirect effect of Support for PrEP on prescription history did not include zero (B = 1.59, 95% BsCI [0.83, 3.57]) demonstrating that the effect of support for PrEP is mediated by knowledge of PrEP. The most commonly identified barrier to prescribing PrEP was the lack of drug coverage among patients.

Conclusion: The results of the mediation analysis support the IMB skills model regarding support for PrEP, Knowledge of PrEP, and having prescribed PrEP in the past. Our findings suggest that to improve PrEP uptake in Nova Scotia, educational interventions for physicians and universal coverage of the drug would be necessary.