Analysis of HIV Drug Prophylaxis Services Cascade in Healthcare Workers: a Cross-sectional Study in China

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2024 Jan 3

PMID 38166686

Authors

Jingkun Hu

Wenting Kang

Jiahuan Guo

Jie Xu

Fan Lyu

Guang Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Human immunodeficiency virus (HIV) drug prophylaxis, including post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), has not yet been generally recognized and accepted by the whole society in China, and the utilization coverage among high-risk populations is low. Healthcare workers (HCWs) are important to the promotion and implementation of HIV drug prophylaxis strategy. This study analyzed the HIV drug prophylaxis services cascade (knowledge, attitude, and service) in HCWs, and explored the correlations between PEP and PrEP.

Methods: A cross-sectional study was conducted among 1066 HCWs in 20 designated hospitals for HIV antiretroviral therapy in 20 cities in China. We collected information on participants' essential characteristics, HIV drug prophylaxis services cascade (knowledge, attitude, and service) and so on. The Chi-square test was used to analyse whether the differences and correlations between categorical variables were statistically significant, and Pearson contingency coefficient was used to analyse the strength of correlations. Multivariable logistic regression was used to analyse associated factors.

Results: Among three stages of HIV drug prophylaxis services cascade, a high percentage of 1066 participants had knowledge of HIV drug prophylaxis (PEP: 78.2%, PrEP: 80.0%). Of them, almost all had supportive attitudes towards HIV drug prophylaxis (PEP: 99.6%, PrEP: 98.6%). Only about half of them would provide HIV drug prophylaxis services (PEP: 53.5%, PrEP: 48.5%). There were positive correlations between knowledge of PEP and PrEP (r = 0.292), between attitudes toward PEP and PrEP (r = 0.325), and between provision of PEP services and PrEP services (r = 0.555) in HCWs.

Conclusions: There was a positive correlation between PEP and PrEP in HCWs. At the stage of providing HIV drug prophylaxis services, training, advocacy and education for HCWs, should be targeted and also combine PEP and PrEP to maximize the effects, so as to improve the enthusiasm of HCWs to provide HIV drug prophylaxis services.

References

Krishnaratne S, Hensen B, Cordes J, Enstone J, Hargreaves J . Interventions to strengthen the HIV prevention cascade: a systematic review of reviews. Lancet HIV. 2016; 3(7):e307-17. DOI: 10.1016/S2352-3018(16)30038-8. View

Mistler C, Copenhaver M, Shrestha R . The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review. AIDS Behav. 2020; 25(5):1490-1506. PMC: 7858689. DOI: 10.1007/s10461-020-02988-x. View

Wisutep P, Sirijatuphat R, Navanukroh O, Phatharodom P, Werarak P, Rattanasuwan W . Attitudes towards, knowledge about, and confidence to prescribe antiretroviral pre-exposure prophylaxis among healthcare providers in Thailand. Medicine (Baltimore). 2021; 100(49):e28120. PMC: 8663816. DOI: 10.1097/MD.0000000000028120. View

Sell J, Chen R, Huber C, Parascando J, Nunez J . Primary Care Provider HIV PrEP Knowledge, Attitudes, and Prescribing Habits: A Cross-Sectional Survey of Late Adopters in Rural and Suburban Practice. J Prim Care Community Health. 2023; 14:21501319221147254. PMC: 9834790. DOI: 10.1177/21501319221147254. View

Sousa L, Elias H, Fernandes N, Gir E, Reis R . Knowledge of PEP and PrEP among people living with HIV/aids in Brazil. BMC Public Health. 2021; 21(1):64. PMC: 7788867. DOI: 10.1186/s12889-020-10135-3. View

He N . Research Progress in the Epidemiology of HIV/AIDS in China. China CDC Wkly. 2021; 3(48):1022-1030. PMC: 8633551. DOI: 10.46234/ccdcw2021.249. View

Cao W, Sun S, Peng L, Gu J, Hao C, Li J . Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China. BMC Public Health. 2020; 20(1):337. PMC: 7077166. DOI: 10.1186/s12889-020-08488-w. View

Gandhi R, Bedimo R, Hoy J, Landovitz R, Smith D, Eaton E . Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2022; 329(1):63-84. DOI: 10.1001/jama.2022.22246. View

Yuan D, Yin Y, Chen J, Lu J, Zhou Y, Fu G . Acceptability of HIV pre-exposure prophylaxis in China: A systematic review and meta-analysis. Int J STD AIDS. 2022; 33(3):218-231. DOI: 10.1177/09564624211042308. View

10.

Sha Y, Li C, Xiong Y, Hazra A, Lio J, Jiang I . Co-creation using crowdsourcing to promote PrEP adherence in China: study protocol for a stepped-wedge randomized controlled trial. BMC Public Health. 2022; 22(1):1697. PMC: 9449927. DOI: 10.1186/s12889-022-14117-5. View

11.

Yan L, Yan Z, Wilson E, Arayasirikul S, Lin J, Yan H . Awareness and Willingness to use HIV Pre-exposure Prophylaxis (PrEP) Among Trans Women in China: A Community-Based Survey. AIDS Behav. 2020; 25(3):866-874. PMC: 7886947. DOI: 10.1007/s10461-020-03050-6. View

12.

Wang H, Wang Z, Huang X, Chen Y, Wang H, Cui S . Association of HIV Preexposure Prophylaxis Use With HIV Incidence Among Men Who Have Sex With Men in China: A Nonrandomized Controlled Trial. JAMA Netw Open. 2022; 5(2):e2148782. PMC: 8851305. DOI: 10.1001/jamanetworkopen.2021.48782. View

13.

Wang H, Tang W, Shang H . Expansion of PrEP and PEP services in China. Lancet HIV. 2022; 9(7):e455-e457. DOI: 10.1016/S2352-3018(22)00138-2. View

14.

John S, Quinn K, Pleuhs B, Walsh J, Petroll A . HIV Post-Exposure Prophylaxis (PEP) Awareness and Non-Occupational PEP (nPEP) Prescribing History Among U.S. Healthcare Providers. AIDS Behav. 2020; 24(11):3124-3131. PMC: 7508835. DOI: 10.1007/s10461-020-02866-6. View

15.

Godfrey-Faussett P . The HIV prevention cascade: more smoke than thunder?. Lancet HIV. 2016; 3(7):e286-8. DOI: 10.1016/S2352-3018(16)30062-5. View

16.

Xu J, Han M, Jiang Y, Ding H, Li X, Han X . Prevention and control of HIV/AIDS in China: lessons from the past three decades. Chin Med J (Engl). 2021; 134(23):2799-2809. PMC: 8667973. DOI: 10.1097/CM9.0000000000001842. View

17.

Xu J, Tang W, Zhang F, Shang H . PrEP in China: choices are ahead. Lancet HIV. 2019; 7(3):e155-e157. DOI: 10.1016/S2352-3018(19)30293-0. View

18.

Pleuhs B, Quinn K, Walsh J, Petroll A, John S . Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review. AIDS Patient Care STDS. 2020; 34(3):111-123. PMC: 7087402. DOI: 10.1089/apc.2019.0189. View

19.

Peng Q, Liu X, Tang X, Zhang Q, Zhao J, Zheng C . Low rate of pre-exposure prophylaxis and post-exposure prophylaxis uptake and high prevalence of transmitted drug resistance among newly diagnosed primary HIV infections in Shenzhen, China: a real-world retrospective study. Chin Med J (Engl). 2023; 135(22):2730-2737. PMC: 9945328. DOI: 10.1097/CM9.0000000000002510. View

20.

Burki T . HIV in China: a changing epidemic. Lancet Infect Dis. 2018; 18(12):1311-1312. DOI: 10.1016/S1473-3099(18)30680-7. View