Australian prescribers' perspectives on ART initiation in the era of “treatment as prevention”

Abstract

This study explores Australian prescribers' attitudes towards Treatment as Prevention (TasP) and their practices around initiating combination antiretroviral treatment (cART) for HIV. A brief online survey was conducted nationally amongst antiretroviral treatment (ART) prescribers in Australia. The sample broadly represented ART prescribers in Australia (N = 108), with 40.7% general practitioners (GPs), 25.9% sexual health clinic-based physicians and 21.3% hospital-based infectious diseases physicians. About 60% of respondents had been treating HIV-positive patients for more than 10 years. Respondents estimated that about 70–80% of all their HIV-positive patients were receiving ART. Over half of the prescribers agreed very strongly that their primary concern in recommending cART initiation was clinical benefit to individual patients rather than any population benefit. A majority of the prescribers (68.5%) strongly endorsed cART initiation before CD4+ T-cell count drops below 350 cells/mm³, and a further 22.2% strongly endorsed cART initiation before CD4+ T-cell count drops below 500 cells/mm³. Regarding the optimal timing of cART initiation, this study shows that prescribers in Australia in 2012 focus primarily on the benefits for their individual patients. Prescribers may need more convincing evidence of individual health benefits or increased knowledge about the population health benefits for a TasP approach to be effective in Australia.

Keywords:

• antiretroviral treatment
• treatment initiation
• HIV prevention
• treatment uptake
• HIV clinical markers

Acknowledgements

This study is funded by the Australian National Health and Medical Research Council (APP1021790). The National Centre in HIV Social Research is supported by the Australian Government Department of Health and Ageing. We thank the collaborators and members of our Research Advisory Committee: the National Centre in HIV Social Research (Martin Holt, Henrike Körner, Asha Persson); the Kirby Institute (David Wilson, Andrew Grulich, Kathy Petoumenos and David Cooper); the National Association of People Living with HIV Australia (Jo Watson); the Australasian Society for HIV Medicine (Tim Stern); the Australian Federation of AIDS Organisations (Simon Donohue); NSW Multicultural HIV and Hepatitis Service (Tadgh McMahon); NSW Positive Central and Heterosexual HIV Service (Pene Manolas). We are grateful to the contribution made by the study participants.