Transcript powerpoint

Antiretroviral Therapy
(ART) for HIV Prevention:
Attitudes and practice amongst healthcare
providers in HIV and STI care in Ireland
Garvey P, Kiernan J, O’Leary A, Hurley C, Lyons F
SSSTDI Autumn Meeting
26th November 2016
ART for HIV Prevention
• Pre-Exposure Prophylaxis (PrEP)
• Treatment as Prevention (TasP)
• Post-Exposure Prophylaxis (PEP)
National Sexual Health Strategy 2015-2020
• Priority Action:
– “Prioritise, develop and implement guidance to
support the appropriate use of antiretroviral
therapy (ART) in HIV prevention.”
• Currently in Ireland
– PEP Guidelines in place since 2012 (EMI Toolkit)
• Updated August 2016, www.emitoolkit.ie
– No national guidelines for TasP or PrEP
Aims
• Determine attitudes and practice amongst
healthcare providers in Ireland in relation to
– Timing of ART initiation (TasP)
– PrEP for HIV prevention
• Inform the work of the HSE Sexual Health &
Crisis Pregnancy Programme
Method
Study Design
• Ethical approval obtained from RCPI REC
• List generated from HIV and STI Services
– Targeting those involved in one to one
consultations
• Cross sectional survey of HCPs involved in HIV
and STI care
– Questions about timing of ART initiation for HIV
HCPs
– Questions about PrEP for all respondents
Data Collection and Analysis
• Self administered anonymous online
questionnaire
– Demographix Survey Tool
• Proportions calculated
– categorical variables using non-missing values as
denominators
• Medians calculated
– numerical variables
Results
Respondent Characteristics
• 67/118(57%) responded
– 36 (54%) medical
– 26 (39%) nursing
– 5 (7%) pharmacists
• Care provided
– 21 (31%) HIV & STIs
– 20 (30%) HIV
– 26 (39%) STIs
• Experience (median)
– HIV 13 years
– STI 12 years
ART Initiation
HIV Case Load
Characteristic
Women
Heterosexual men
Percentage of HIV
patients by HIV risk Vertically-infected
adolescents (<18 years old)
group
People who inject drugs
(N=41)
Men who sex with men/
transgender/transsexual
Ireland
Percentage of HIV Sub-Saharan Africa
patients by country South America
of origin
EU other than Ireland
(N=41)
Asia
Other
Median Range
25
20
0.5-50
3-70
1
0-10
20
1-95
45
5-95
45
30
15
10
5
5
10-90
2-70
0-60
2-50
0-10
0-19
Initiation of ART - Practice
Guidelines used for
timing of ART initiation
(N=40)
Guidelines used for
choice of ART (N=40)
Factors prompting
respondent to
recommend ART (N=38)
n
32
25
9
2
29
25
8
2
%
80
63
23
5
73
63
20
5
37
97
36
95
35
92
HIV infected patient newly diagnosed with an STI
32
84
HIV infected patient actively injecting drugs
31
82
BHIVA
EACS
DHHS
None of the above
BHIVA
EACS
DHHS
None of the above
HIV infected patient having unprotected sex with
partner(s) of unknown HIV status
HIV infected patient in a HIV discordant sexual
partnership (patient’s partner is HIV negative)
HIV infected patient with high viral load (>100,000
copies/mm3) and CD4≥500
Initiation of ART - Practice
• “In general, I recommend ART for HIV-infected
patients irrespective of CD4 count”
– 33/36 (92%) indicated they agreed (19%) or strongly
agreed (72%) with the statement
Characteristic
Percentage on ART
HIV clinical case load
(N=23)
Number HIV reviewed in last
typical month of service
Percentage in whom you
initiated ART in the last
typical month of service
Median
Range
90
70-100
80
3-200
5
0-30
Initiation of ART - Attitudes
• Early initiation of ART can slow the spread of
HIV in the community
– 40/40 (100%) agreed or strongly agreed
• Ireland should adopt policy of offering ART to
all HIV infected individuals
– 39/41 (95%) said “yes”
PrEP
PrEP Awareness & Attitudes
• “Have you heard of PrEP?”
– 66/66 (100%), said “yes”
• “PrEP should be available in Ireland to
individuals at high risk for HIV”
– 55/66 (83%), agreed or strongly agreed
• “Likelihood of recommending PrEP to high-risk
individuals
– 31/34 (91%) likely or very likely
PrEP Statements
PrEP should only be implemented as part of an
overall HIV prevention programme
The use of PrEP will cause patients to engage in
riskier behaviours
The use of PrEP will select for, and disseminate,
antiretrovirial drug resistance
The use of PrEP will result in less funding for
general sexual health services
I am concerned about potential side effects
I am concerned that PrEP is not effective
0%
Strongly Agree
Agree
20%
Neutral
40%
Disagree
60%
Strongly Disagree
80%
100%
“Who is going to
look after this
cohort, the
services are
already bursting
at the seams”
PrEP Comments
“The non availability of PrEP
is hugely concerning and is
impacting on new HIV
infection rates. The gay sex
landscape has changed...
Unsafe sex is now routinely
part of the sexual repertoire
and the use of recreational
drugs have impacted on
MSM sexual practises”
“I do not consider it to
be an appropriate use
of taxpayers money.
Condoms are a
cheaper alternative”
“Politically supplying
PrEP free of charge
would cause
difficulty in the
context of rationing
of healthcare”
“Costs may decline
when medications
in generic form
become available”
“Costly prophylaxis
that potentially
promotes and
endorses risky sexual
behaviours ...
Potential for acquiring
resistant strains of
HIV and possible
increase in STIs”
Limitations
• No directory of relevant HCPs
• Response rate
Conclusions
• ART Initiation
– In favour of TasP
– Current practice
• PrEP
– In favour of PrEP
– Overall HIV prevention
– Implications
What Now?
• ART initiation
– HSE position statement on ART for all people with
HIV
• PrEP
– Helped inform how we
should proceed with PrEP
in Ireland
Thank You
Any Questions?