Portuguese health care providers' knowledge, attitudes, and acceptability of HIV pre-exposure prophylaxis

Introduction: Evidence shows that pre-exposure prophylaxis (PrEP) is highly effective in preventing sexually acquired human immunodeficiency virus (HIV) infection. Whilst its implementation is limited to the US and some countries where demonstration projects have taken place, PrEP has recently been introduced in Portugal. Successful implementation of PrEP requires actively engaging and involving of health care providers (HCP) in Portugal, yet little is known about their knowledge, attitudes, and acceptability towards this novel intervention. Material and methods: An online survey of convenience-sampled Portuguese HCP was conducted in January 2016, prior to PrEP implementation, to determine their knowledge, attitudes, practices, and acceptability of PrEP. Results: A total of 96 respondents nationwide took part in the study, of whom the majority were females (60.3%), specialist physicians/junior doctors (39%/53%), working in the field of HIV for 1 to 5 years (42.3%). Over half (51%) considered having an average or high knowledge of PrEP, and this was more common amongst infectious diseases specialists. Major concerns regarding PrEP implementation included a rise in sexually transmitted infections and increased antiretroviral resistance. Despite only 31.3% being asked about PrEP in the future, the majority (75%) considered that PrEP should be made available in Portugal. The main barrier to PrEP implementation was the lack of knowledge and information to HCP. Conclusions: Portuguese HCP demonstrated variable degrees of knowledge around PrEP, yet most would support its introduction in the country. Concerns were raised about potential consequences of PrEP roll out as well as implementation challenges that ought to be addressed before PrEP introduction.