Global clinician perceptions of HIV treatment as prevention (TasP): results of a 2014 IAPAC/IAS clinician survey
Background: Prospective randomized studies and observational cohorts have shown that earlier initiation of antiretroviral therapy (ART) is associated with lower rates HIV transmission. US and World Health Organization treatment guidelines now recommend ART for the prevention of HIV transmission. Provider beliefs about TasP are not well characterized.
Methods: We fielded an online English language survey to clinician networks of the International Association of Providers of AIDS Care (IAPAC) and the International AIDS Society (IAS) from December 2013 through January 2014. Respondents were recruited using email and social media.
Results: There were 1,464 respondents (18% sub-Saharan Africa, 15% North America; 11% Western Europe; ~10% each: Latin America, S/SE Asia, Eastern Europe/Central Asia; 7% each: East Asia, Caribbean, N Africa/Middle East and Oceana). Regarding the perception of TasP by medical providers from their countries, 46% felt that providers were in agreement with TasP, while 37% responded that providers were unsure/more data were needed and 17% were opposed. Barriers to TasP implementation included: funding (cited by 25%), patient acceptance (15%), inadequate scientific data (13%), stakeholder acceptance (13%), and workforce shortage (11%). 43% felt that additional research was needed. Overall, 78% stated that TasP implementation should proceed, with 57% stating that additional research was needed (without stopping implementation); these opinions were similar across geographic regions. Only 21% stated that additional research was needed and TasP implementation should be deferred.
Conclusions: While current normative guidance supports TasP, in this large global convenience sample of HIV care providers, less than half felt that their country''s providers were in agreement with TasP. A large majority of these providers across all geographic regions felt that TasP should be implemented and a minority felt that additional research is needed prior to implementation. These findings point to substantial gaps between guidance and provider opinions and suggest the need for targeted educational during the expansion of antiretroviral coverage and TasP.
B. Young1, M. Kurian2, I. Sidibe1, J.S.G. Montaner3, J.M. Zuniga1
1International Association of Providers of AIDS Care, Washington, United States, 2International AIDS Society, Geneva, Switzerland, 3University of British Columbia, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada