Amsterdam 2015
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| Abstract #2019 - Circumcision and TasP: Biomedical interventions | ||||
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Session: 27.5: Circumcision and TasP: Biomedical interventions (Parallel) on Thursday @ 11.30-13.00 in C001 Chaired by Catherine Adams, Fraukje Mevissen Authors: Presenting Author: Dr Limin Mao - UNSW, Australia |
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| Additional Authors: | ||||
| Aim: The effectiveness of Treatment as Prevention (TasP) to curb the HIV epidemic in real-life settings is influenced by a wide range of issues, with attention currently focused on the importance of enabling regulations and systems. In contexts where early ART is available and affordable, whether TasP will be taken up depends on patients’ willingness to use and doctors’ willingness to prescribe early ART. This paper examines doctors’ attitudes and practices regarding starting ART. | ||||
| Method / Issue: Repeat surveys amongst ART-prescribers in Australia assessed and monitored their attitudes regarding TasP, as well as their practices regarding the initiation of ART. All registered ART-prescribers in Australia received an invitation to complete a brief, anonymous online self-report questionnaire from their professional society, the Australasian Society for HIV Medicine. | ||||
| Results / Comments: An initial survey was undertaken in April-May 2012, with valid responses obtained from 108 ART-prescribers (response rate 51%). Local family doctors were the largest group (40.7%), followed by sexual health physicians (25.9%) and infectious disease specialists (21.3%). Participants’ average age was 48.1 years and most (60.2%) had over 10 years experience in HIV medicine. A follow-up survey was carried out from mid-May to mid-July 2013, with valid responses obtained from 82 ART-prescribers. Sample characteristics were similar across surveys. In 2012, only one in five (18.6%) participating ART-prescribers agreed that public health concerns regarding the reduced likelihood of onward HIV transmission were an important consideration in recommending the initiation of ART. In 2013, nearly half (45.1%) of participating prescribers agreed. Also, whereas in 2012 the majority (68.5%) most strongly recommended the initiation of ART at CD4-cell counts below 350 CD4+ cells/ml, in 2013 the majority (56.1%) recommended initiating ART below 500 CD4+ cells/ml or upon diagnosis. Furthermore, in 2013, half (49.3%) of the prescribers indicated having initiated ART in one or more patients with the main goal of preventing HIV transmission. | ||||
| Discussion: Decisions about the initiation of ART are ultimately taken in the privacy of consultations between patients and providers, and the practices of ART-prescribers are instrumental to the success of TasP. The findings show that ART-prescribers in Australia are becoming more supportive of initiating ART for prevention, and illustrate a process of changing attitudes and practices that plays a critical but as yet under-researched role in the implementation of TasP. | ||||
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