RESUMO
BACKGROUND: Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP. METHODS: We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks' domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation. RESULTS: We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care. CONCLUSION: Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system.
RESUMO
En octubre del 2014, ONUSIDA estableció la estrategia del 90 90 90 para la erradicación de la epidemia del SIDA para el año 2030 en el mundo, meta alcanzable si los países se comprometen a captar el 90% de las personas infectadas con el virus, tratar de manera continua y sostenible el 90% de los diagnosticados y lograr supresión viral al 90% de los tratados para el año 20201. Estos ambiciosos objetivos implican la implementación desde políticas agresivas de salud pública con la estrategia "Diagnosticar y Tratar" (Test and Treat) hasta un manejo integral individualizado del paciente por grupos multidisciplinarios de expertos. Es al interior de estos grupos en los que se logrará el último 90, el éxito virológico, crucial para disminuir la transmisibilidad de la infección y mejorar la expectativa y la calidad de vida de las personas viviendo con el VIH.
In October 2014, UNAIDS established the 90 90 90 strategy for the eradication of the AIDS epidemic by 2030 worldwide, a goal achievable if countries commit to capturing 90% of people infected with the virus, continuously and sustainably treating 90% of those diagnosed, and achieving viral suppression in 90% of those treated by 20201. These ambitious objectives imply the implementation of aggressive public health policies with the "Test and Treat" strategy, as well as comprehensive individualized patient management by multidisciplinary groups of experts. It is within these groups that the ultimate virological success will be achieved, which is crucial to reduce the transmissibility of the infection and improve the life expectancy and quality of life of people living with HIV.
