AC-2020-12-1420.R1 – HIV care providers’ familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study

Figures & data

Table 1. General characteristics and intention to provide PrEP care in a sample of health care workers of Colombian HIV clinics.

	Physicians		Non Physicians		Total		P-Value
Age (average; SD)	39.4	9.9	36.1	8.6	37.5	9.3	0.0553
	n	%	n	%	n	%
Sex
Male	36	65.4	15	20.3	51	39.5	<0.001
Female	19	34.6	59	79.7	78	60.5
Years of HIV-related practice
Less than 5 years	19	37.3	40	56.3	59	48.4	0.029
5 - 10 years	13	25.5	19	26.8	32	26.2
More than 10 years	19	37.3	12	16.9	31	25.1
Health care discipline
HIV specialist	34	61.8	0	0	34	26.4
Infectious Disease specialist	6	10.9	0	0	6	4.6
General Physician	12	21.8	0	0	12	9.3
Specialist-(other than Infectious Disease specialist)	3	5.4	0	0	3	2.3
Nurse	0	0	31	41.9	31	24.0
Pharmacist	0	0	14	18.9	14	10.8
Social worker	0	0	9	12.2	9	6.9
Psychologist	0	0	16	21.6	16	12.4
Other	0	0	4	5.4	4	3.1
Job focus
“More than 90% of my time is dedicated to managing the clinic”	1	1.8	17	22.9	18	13.9	<0.001
“Most of my time dedicated to the care of patients”	45	81.8	32	43.2	77	59.7
“I have both, administrative and clinical work”	9	16.4	25	33.8	34	26.4
Intention: Extremely likely/very likely
Willing to provide PrEP-related care to patients	50	92.6	47	82.5	97	87.4	0.153
Has the intention to provide PrEP-related care	48	88.9	46	80.7	94	84.7	0.295
Has a plan to provide PrEP-related care	39	72.2	30	52.6	69	62.2	0.026
Would advocate for PrEP implementation in his/her organization	43	79.6	31	54.4	74	66.7	0.005

Table 2. Familiarity, skills, and experience with PrEP in health care workers from HIV clinics in Colombia.

	Physicians		Non-Physicians		Total		P-Value
Self-perceived knowledge on PrEP	n	%	n	%	n	%
Never heard about	1	1.8	4	5.4	5	3.9	<0.001
Very little knowledge	2	3.6	12	16.2	14	10.8
Some knowledge	8	14.6	38	51.3	46	35.7
Good PrEP knowledge	33	60.0	20	27.0	53	41.1
A lot of knowledge	11	20.0	0	0.0	11	8.5
Familiarity
How well do you know PrEP guidelines?	P50	RIC	P50	RIC	P50	RIC
CDC guidelines	4.0	1.2	2.0	1.8	3.0	2.4	<0.001
WHO PrEP guidelines	3.9	1.6	2.0	1.8	2.2	2.4	0.0001
Latin America PrEP guidelines	3.0	2.8	1.5	1.0	2.0	1.9	0.0014
Perceived knowledge of specific aspects of PrEP
PrEP efficacy on preventing HIV	4.4	1.0	3.0	2.0	4	1.5	0.0001
Frequency and severity of PrEP medications adverse effects	4.4	1.0	3.0	2.1	4	2.4	0.0001
Determining who could benefit from PrEP	4.6	1.0	4.0	1.8	4.1	1.9	0.0001
PrEP-related counseling	4.1	1.9	2.9	2.2	3.6	2.7	0.0001
Medications used for PrEP	5.0	0.7	3.8	2.4	4.1	2.0	0.0001
PrEP experience	n	%	n	%	n	%
Has anyone ever asked you about PrEP? Yes	47	87.0	39	68.4	86	77.5	0.019
Have you ever initiated a conversation about PrEP with one of your patients? Yes	38	70.4	25	43.9	63	56.8	0.005
Have you ever managed PrEP patients? Yes	9	16.4	6	8.1	15	11.6	0.157
When you talk about PrEP you feel …	n	%	n	%	n	%
Enthusiastic	21	38.2	4	5.4	25	19.4	<0.001
Neutral	14	25.4	18	24.3	32	24.8
Not enthusiastic	2	3.6	2	2.7	4	3.1
Anxious	1	1.8	1	1.3	2	1.6
No response	17	30.9	49	66.2	66	51.2
PrEP Training (Yes)	n	%	n	%	n	%
PrEP guidelines	22	41.5	5	8.8	27	24.6	<0.001
How to provide care to PrEP patients	15	28.3	5	8.8	20	18.2	0.012
PrEP-related counseling	14	25.9	8	14.0	22	19.8	0.154
Use of instrument to identify PrEP-eligible patients	9	16.9	2	3.5	11	10.0	0.025
Need more training (agree/completely agree)	45	83.3	56	98.2	101	91.0	0.007

P50: percentile 50; RIC: interquartile range.

Table 3. Health care providers’ experience and comfort with PrEP-related activities in HIV clinics in Colombia.

	Physicians		Non-Physicians		Total		P-Value
Perception on the number of patients seen in the participant’s clinic from/to whom he/she … (proportion who reported “all or most of the patients”)	n	%	n	%	n	%
takes a sexual history	50	92.6	41	71.9	91	82.0	0.006
asks about risky or preventive behaviours	51	94.4	53	93.0	104	93.7	1.000
asks about sexual orientation	50	92.6	42	73.7	92	82.9	0.011
asks about their sexual partners’ HIV serostatus	48	88.9	46	80.7	94	84.7	0.295
counsels on HIV risk reduction	50	92.6	53	93.0	103	92.8	1.000
asks about gender identity	44	81.5	39	68.4	83	74.8	0.130
Frequency of activities (Every day-several times a week)
offering HIV testing	19	35.2	5	8.8	24	21.6	0.001
performing counseling on medication adherence	40	74.1	46	80.7	86	77.5	0.497
informing someone about a positive HIV test	13	24.1	18	31.6	31	27.9	0.405
asking patients about HIV medication adverse effects	42	77.8	41	71.9	83	74.8	0.518
performing HIV medication monitoring	41	75.9	34	59.7	75	67.6	0.073
offering diagnostic testing for sexually transmitted infections	43	79.6	7	12.3	50	45.0	<0.001
Comfort level (Totally comfortable-very comfortable)
asking patients about their sexual history	48	88.9	43	81.1	91	85.0	0.291
asking patients about their either risk or preventative behaviors	49	90.7	47	82.5	96	86.5	0.270
Asking the sexual orientation	44	81.5	44	81.5	88	81.5	1.000
asking about sex partners HIV serostatus	49	90.7	50	90.9	99	90.8	1.000
providing counsel on HIV risk reduction	52	96.3	53	93.0	105	94.6	0.679
asking about gender identity	45	83.3	43	81.1	88	82.2	0.805
offering HIV testing	50	94.3	44	95.7	94	95.0	1.000
counselling on HIV medication adherence	51	98.1	56	100.0	107	99.1	0.481
disclosing the HIV diagnosis to a patient	44	84.6	34	75.6	78	80.4	0.311
prescribing HIV medications	52	98.1	47	92.2	99	95.2	0.201
asking about HIV medication side effects	51	96.2	53	94.6	104	95.4	1.000
offering diagnostic tests for sexually transmitted diseases	54	100.0	36	83.7	90	92.8	0.003

Table 4. Health care workers negative attitudes, and concerns around PrEP in HIV clinics in Colombia.

Negative attitudes (completely agree/agree)	Physicians		No physicians			Total
	n	%	n	%	p-value	n	%
1.PrEP could cause more harm than good if not correctly implemented	33	64.7	50	71.4	0.431	83	68.6
2. PrEP will lead to decreased condom use	36	70.6	52	74.3	0.683	88	72.7
3. I believe it is unethical to prescribe HIV medications to healthy individuals	1	1.9	13	18.6	0.004	14	11.6
4. There are better alternatives for HIV prevention than PrEP	10	19.6	29	41.4	0.017	39	32.2
5. PrEP would not be better than current HIV prevention strategies	4	7.8	19	27.1	0.009	23	19.0
6. Few people in Colombia need PrEP	3	5.9	2	2.9	0.649	5	4.1
Concerns about adherence and drug resistance (A lot of concern)
1. Increased resistance to HIV medications	27	49.1	48	64.9	0.104	75	58.1
2. Lack of compliance with monitoring	46	83.6	62	83.8	1.00	108	83.7
3. Suboptimal medication adherence	47	85.4	58	78.4	0.365	105	81.4
4. Medication misuse, e.g., saling medications	50	90.9	61	82.4	0.205	111	86.1
Health system-related concerns (A lot of concern)
1.That the health care system does not approve PrEP medications.	41	74.6	47	64.4	0.251	88	68.7
2. Insufficient time to monitor and counsel people in PrEP	39	70.9	48	65.7	0.571	87	67.9
3.That the health care plans do not cover PrEP	37	67.3	47	64.4	0.851	84	65.6
4. That the health system does not allow to monitor people in PrEP.	41	74.6	53	72.6	0.842	94	73.4

Table 5. Univariate Poisson regression analysis of the factors associated with having a plan to manage people on PrEP in health care workers of Colombian HIV clinics

Variables	Prevalence ratio	[Conf. Int-95%]		P-value
Age(quartile)
≤ 29 years	reference
30–37 years	1.428	0.929	2.195	0.104
38–43 years	1.250	0.777	2.011	0.358
>43 years	1.273	0.788	2.056	0.324
Sex (Male)	1.335	1.001	1.781	0.049
HCW (Physicians vs non-physicians)	1.372	1.018	1.849	0.037
Familiarity with PrEP
Self-perceived knowledge about PrEP (some knowledge + a lot of knowledge vs others)	1.371	1.013	1.854	0.041
Knows any of the PrEP guidelines (yes vs no)	1.376	1.035	1.829	0.028
Knows clinical aspects of PrEP (scale from 5 to 25)	1.016	0.987	1.044	0.278
PrEP-related training
Having ever received PrEP training, Yes vs no	1.307	0.980	1.742	0.068
Need more training (agree/completely agree vs other categories)	0.647	0.497	0.843	0.001
Experience with PEP - (at least once a month vs other categories)	0.868	0.512	1.473	0.601
Experience in clinical activities related to PrEP
Number of people in whom PrEP-relevant activities are performed (scale from 9 to 30)	1.055	1.009	1.103	0.018
Frequency of the activity (scale from 6 to 42)	1.013	0.996	1.029	0.133
Comfort level
Level of comfort(scale from 22 to 60)	1.018	0.998	1.040	0.083
PrEP-attitudes and related concerns
Level of agreement with negative attitudes (scale from 2 to 22)	0.986	0.944	1.029	0.514
Level of concern on medication use (scale from 8 to 20)	1.016	0.962	1.073	0.569
Level of concerns on health system barriers (scale from 4 to 24)	0.992	0.949	1.036	0.708