Willingness to Recommend Pre-Exposure Prophylaxis for HIV Prevention
Among Mexican Non-Physician Health Providers: A Cross-Sectional Study

Dulce   María   Díaz-Sosa; Centli      Guillen-Díaz-Barriga; Rebeca      Robles-García; Hamid      Vega-Ramírez

doi:10.2174/1570162X21666221125150535

Abstract

Background: Pre-exposure prophylaxis (PrEP) has recently been introduced in Mexico. Still, there are no data exploring the frequency and related factors of willingness to recommend it among non-physician health providers (Non-PHP).

Objective: Compare awareness, knowledge, attitudes, and willingness to recommend PrEP and combined HIV prevention among Mexican non-PHP.

Methods: We conducted an online survey assessing data on sociodemographics, awareness, knowledge, and willingness to recommend PrEP. We performed a descriptive and comparative analysis between those willing and unwilling to recommend PrEP.

Results: The final sample was 142 participants, and most were willing to recommend PrEP (79.6%). This group reported higher confidence in evaluating PrEP eligibility (90.1%, p<.01), identified that populations at increased risk of HIV would benefit the most from PrEP (p≤.05), and considered the lack of professionals to prescribe PrEP as a barrier (60.7%, p<.01), and were more likely to recommend post-exposure prophylaxis (95.6%, p<.01) compared to those not willing to recommend PrEP. On the other hand, more non-PHP unwilling to recommend PrEP considered that behavioral interventions should be prioritized over PrEP (89.3%, p<.05), PrEP should not be provided in public services (43.3%, p<.001), and the demand of PrEP users would be low to maintain PrEP as a public policy (34.5%, p<.05).

Conclusion: A high proportion of Mexican non-PHP is willing to recommend PrEP. Still, it is necessary to increase their PrEP knowledge, including improving their prejudices and beliefs, so they can identify and refer potential PrEP users based on their risk of getting HIV.

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[1]
Joint United Nations Programme on HIV/AIDS. Fact Sheet - Global
HIV Statistics: UNAIDS. 2021. Available from: http://www.unaids.
org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf Accessed
on: 7/20/2021.

[2]
National Center for the Prevention and Control of HIV and AIDS
(CENSIDA).. Historical Report of HIV, 1st quarter 2022.  Available from: https://www.gob.mx/cms/uploads/attachment/file/750178/
Informe_Hist_rico_VIH_DVEET_1er_TRIMESTRE_2022_Frev.pdf Accessed on: 2/22/2022.

[3]
Joint United Nations Programme on HIV/AIDS.. Country factsheets
Mexico: 2021 Change: UNAIDS. 2021. Available from: https://www.unaids.org/en/regionscountries/countries/mexico Accessed
on: 9/10/2022.

[4]
Cortés AJ. On how role versatility boosts an STI. J Theor Biol  2018; 440: 66-9.
 [http://dx.doi.org/10.1016/j.jtbi.2017.12.018] [PMID:  29273545]

[5]
Joint United Nations Programme on HIV/AIDS.. UNAIDS Terminology
Guidelines: UNAIDS 2015. Available from: https://www.unaids.org/sites/default/files/media_asset/2015_terminol
ogy_guidelines_en.pdf (Accessed on: 7/20/2021).

[6]
Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: A cohort study. Lancet Infect Dis  2014; 14(9): 820-9.
 [http://dx.doi.org/10.1016/S1473-3099(14)70847-3] [PMID:  25065857]

[7]
World Health Organization.. WHO implementation tool for preexposure
prophylaxis (PrEP) of HIV infection - Module 1: Clinical.
Geneva, Switzerland. 2017. Available from: http://apps.who.int/
iris/bitstream/10665/255889/1/WHO-HIV-2017.17-eng.pdf?ua=1 (Accessed on: 1/29/2021).

[8]
World Health Organization.. What’s the 2+1+1? Event-driven oral preexposure
prophylaxis to prevent HIV for men who have sex with men:
Update to WHO’s recommendation on oral PrEP. Geneva, Switzerland. 2019. Available from: https://apps.who.int/iris/rest/
bitstreams/1239070/retrieve (Accessed on: 1/29/2021).

[9]
Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med  2012; 4(151): 151ra125.
 [http://dx.doi.org/10.1126/scitranslmed.3004006] [PMID:  22972843]

[10]
Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med  2010; 363(27): 2587-99.
 [http://dx.doi.org/10.1056/NEJMoa1011205] [PMID:  21091279]

[11]
Haberer JE. Current concepts for PrEP adherence in the PrEP revolution. Curr Opin HIV AIDS  2016; 11(1): 10-7.
 [http://dx.doi.org/10.1097/COH.0000000000000220] [PMID:  26633638]

[12]
Zhang C, McMahon J, Fiscella K, et al. HIV pre-exposure prophylaxis implementation cascade among health care professionals in the United States: Implications from a systematic review and meta-analysis. AIDS Patient Care STDS  2019; 33(12): 507-27.
 [http://dx.doi.org/10.1089/apc.2019.0119] [PMID:  31821044]

[13]
Carter MR, Aaron E, Nassau T, Brady KA. Knowledge, attitudes, and PrEP prescribing practices of health care providers in Philadelphia, PA. J Prim Care Community Health  2019; 10: 2150132719878526.
 [http://dx.doi.org/10.1177/2150132719878526] [PMID:  31578913]

[14]
Bacon O, Gonzalez R, Andrew E, et al. Brief Report: Informing Strategies to Build PrEP Capacity Among San Francisco Bay Area Clinicians. J Acquir Immune Defic Syndr  2017; 74(2): 175-9.
 [http://dx.doi.org/10.1097/QAI.0000000000001182] [PMID:  27654813]

[15]
Sánchez-Rubio Ferrández J, Martínez Sesmero JM, Navarro Aznárez H, Fernández Espínola S, Escobar Rodríguez I, Ventura Cerdá JM. Perceptions about HIV pre-exposure prophylaxis among healthcare professionals in Spain (PERPPRES Study). Farm Hosp  2016; 40(4): 287-301.
 [PMID: 27571497]

[16]
Desai M, Gafos M, Dolling D, McCormack S, Nardone A. Healthcare providers’ knowledge of, attitudes to and practice of pre-exposure prophylaxis for HIV infection. HIV Med  2016; 17(2): 133-42.
 [http://dx.doi.org/10.1111/hiv.12285] [PMID:  26172217]

[17]
Condesa Specialized Clinic.. Guideline for Specialized Counseling and
Comprehensive Prevention Strategies for HIV & other STIs. Mexico
City, Mexico. 2021. Available from: http://condesadf.mx/pdf/Guia_
Consejeria_Especializada_vFinal_120721.pdf (Accessed on: 1/04/2022).

[18]
 CENSUS. Guideline for HIV Detection. 2018. Available from: https://www.gob.mx/cms/uploads/attachment/file/286892/Gu_a_de_d etecci_n_de_VIH_Censida_2018_VF.pdf (Accessed on: 2/10/2022).

[19]
Torres TS, Konda KA, Vega-Ramirez EH, et al. Factors associated with willingness to use pre-exposure prophylaxis in Brazil, Mexico, and Peru: Web-based survey among men who have sex with men. JMIR Public Health Surveill  2019; 5(2): e13771.
 [http://dx.doi.org/10.2196/13771] [PMID:  31210143]

[20]
Vega-Ramirez H, Torres TS, Guillen-Diaz C, et al. Awareness, knowledge, and attitudes related to HIV pre-exposure prophylaxis and other prevention strategies among physicians from Brazil and Mexico: Cross-sectional web-based survey. BMC Health Serv Res  2022; 22(1): 532.
 [http://dx.doi.org/10.1186/s12913-022-07900-y] [PMID:  35459177]

[21]
CENSUS.. Manual for Specific Organization of the Outpatient Center
for the Prevention and Care of AIDS and Sexually Transmitted Infections
(CAPASITS). 2015. Available from: https://www.gob.mx/cms/
uploads/attachment/file/16841/man_org_capasits.pdf (Accessed on:
2/21/2022).

[22]
CENSUS.. Mexican Guideline for Antiretroviral Treatment for People
Living with HIV. 2021. Available from: https://www.gob.mx/cms/
uploads/attachment/file/712164/Gu_a_TAR_fe_erratas_2022.pdf (Accessed on: 2/10/2022).

[23]
National Institute of Social Security (IMSS).. Pre-exposure prophylaxis
(PrEP) (Profilaxis Pre Exposición [PrEP]). 2021. Available from: https://www.imss.gob.mx/pivihimss/prep

[24]
CENSUS.. Campaign for Pre-Exposure Prophylaxis (PrEP): For prevention,go for it! (Pre-Exposure Prophylaxis (PrEP) Campaign: To prevent, go all out!). 2021. Available from: https://www.gob.mx/
censida/es/articulos/campana-de-la-profilaxis-pre-exposicion-preppara-
prevenir-entrale-con-todo

[25]
Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS Behav  2017; 21(5): 1256-67.
 [http://dx.doi.org/10.1007/s10461-016-1625-1] [PMID:  27885552]

[26]
CENSUS.. Mexican Guideline for Care and Provide Pre-exposureProphylaxis. 2022. Available from: https://www.gob.mx/cms/uploads/
attachment/file/704510/GUI_A_DE_ATENCIO_N_PARA_
OTORGAR_PROFILAXIS_2022.pdf (Accessed on: 2/28/2022).

[27]
Clement ME, Seidelman J, Wu J, et al. An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S. AIDS Care  2018; 30(5): 650-5.
 [http://dx.doi.org/10.1080/09540121.2017.1384534] [PMID:  28971705]

[28]
Newman R, Katchi T, Karass M, et al. Enhancing HIV pre-exposure prophylaxis practices via an educational intervention. Am J Ther  2019; 26(4): e462-8.
 [http://dx.doi.org/10.1097/MJT.0000000000000773] [PMID:  29683840]

[29]
Calabrese SK, Mayer KH. Stigma impedes HIV prevention by stifling patient–provider communication about U = U. J Int AIDS Soc  2020; 23(7): e25559.
 [http://dx.doi.org/10.1002/jia2.25559] [PMID:  32686324]

[30]
Ngure K, Ongolly F, Dolla A, et al. “I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya. J Int AIDS Soc  2020; 23(3): e25466.
 [http://dx.doi.org/10.1002/jia2.25466] [PMID:  32144888]

[31]
National Institute of Statistics and Geography (INEGI).. Classificaton of Religions (Clasificación de las religiones). 2020. Available from: https://www.inegi.org.mx/contenidos/productos/prod_serv/contenidos
/espanol/bvinegi/productos/nueva_estruc/702825197261.pdf (Accessed
on: 8/10/2022).

[32]
Valdez-Montero C, Castillo L, Olvera A, Rodríguez D, Caudillo-Ortega L. Reflection of the social determinants of sexual behavior in men who have sexual relations with men. Nursing Care and Health Education  2015; 2: 34-47.

[33]
Edelman EJ, Moore BA, Calabrese SK, et al. Primary Care Physicians’ Willingness to Prescribe HIV Pre-exposure Prophylaxis for People who Inject Drugs. AIDS Behav  2017; 21(4): 1025-33.
 [http://dx.doi.org/10.1007/s10461-016-1612-6] [PMID:  27896552]

[34]
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  2021; 100(49): e28120.
 [http://dx.doi.org/10.1097/MD.0000000000028120] [PMID:  34889271]

[35]
Calabrese SK, Magnus M, Mayer KH, et al. “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS  2017; 31(4): 196-204.
 [http://dx.doi.org/10.1089/apc.2017.0002] [PMID:  28414261]

[36]
Calabrese SK, Earnshaw VA, Underhill K, et al. Prevention paradox: Medical students are less inclined to prescribe HIV pre‐exposure prophylaxis for patients in highest need. J Int AIDS Soc  2018; 21(6): e25147.
 [http://dx.doi.org/10.1002/jia2.25147] [PMID:  29939488]

[37]
Quaife M, MacGregor L, Ong JJ, et al. Risk compensation and STI incidence in PrEP programmes. Lancet HIV  2020; 7(4): e222-3.
 [http://dx.doi.org/10.1016/S2352-3018(19)30333-9] [PMID:  31767536]

[38]
Covey J, Rosenthal-Stott HES, Howell SJ. A synthesis of meta-analytic evidence of behavioral interventions to reduce HIV/STIs. J Behav Med  2016; 39(3): 371-85.
 [http://dx.doi.org/10.1007/s10865-016-9714-1] [PMID:  26831053]

[39]
Wood BR, McMahan VM, Naismith K, Stockton JB, Delaney LA, Stekler JD. Knowledge, practices, and barriers to HIV preexposure prophylaxis prescribing among Washington State Medical Providers. Sex Transm Dis  2018; 45(7): 452-8.
 [http://dx.doi.org/10.1097/OLQ.0000000000000781] [PMID:  29465664]

[40]
Krakower D, Ware N, Mitty JA, Maloney K, Mayer KH. HIV providers’ perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: A qualitative study. AIDS Behav  2014; 18(9): 1712-21.
 [http://dx.doi.org/10.1007/s10461-014-0839-3] [PMID:  24965676]

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DOI https://dx.doi.org/10.2174/1570162X21666221125150535	Print ISSN 1570-162X
Publisher Name Bentham Science Publisher	Online ISSN 1873-4251

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Willingness to Recommend Pre-Exposure Prophylaxis for HIV Prevention Among Mexican Non-Physician Health Providers: A Cross-Sectional Study

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