Factors of prescribing phage therapy among UK healthcare professionals: Evidence from conjoint experiment and interviews.

With the global challenge of antimicrobial resistance (AMR), interest in the development of antibiotic alternatives has surged worldwide. While phage therapy is not a new phenomenon, technological and socio-economic factors have limited its implementation in the Western world. There is now a resurged effort, especially in the UK, to address these challenges. In this study, we collect survey data on UK general practitioners (n = 131) and other healthcare professionals (n = 103), as well as interviews with medical professionals (n = 4) and a focus group with medical students (n = 6) to explore factors associated with their willingness to prescribe phage therapy to patients. The interviews with medical professionals show support for the expansion of bacteriophage clinical trials and highlight their role as a viable alternative to antibiotics. A conjoint experiment reveals that success rate, side effect rate, and patient attitude to treatment are the decisive factors when it comes to phage therapy prescription; in contrast, the effects of administration route, type of treatment, and severity of infection were not statistically significant. Moreover, we show that general practitioners overall are more likely to recommend phage treatment to patients, compared to other healthcare professionals. The results of the study suggest that phage therapy has a potential to be widely accepted and used by healthcare workers in the UK.

Phage therapy and the public: Increasing awareness essential to widespread use.

Today, the antimicrobial resistance (AMR) crisis is shaping a world where previously treatable infections can kill. This has revitalised the development of antibiotic alternatives, such as phage therapy. The therapeutic use of phages, viruses that infect and kill bacteria, was first explored over a century ago. However, most of the Western world abandoned phage therapy in favour of antibiotics. While the technical feasibility of phage therapy has been increasingly investigated in recent years, there has been minimal effort to understand and tackle the social challenges that may hinder its development and implementation. In this study, we assess the UK public's awareness, acceptance, preferences and opinions regarding phage therapy using a survey, fielded on the Prolific online research platform. The survey contained two embedded experiments: a conjoint and framing experiment (N = 787). We demonstrate that acceptance of phage therapy among the lay public is already moderate, with a mean likelihood of acceptance of 4.71 on a scale of 1 (not at all likely to accept phage therapy) to 7 (very likely to accept phage therapy). However, priming participants to think about novel medicines and antibiotic resistance significantly increases their likelihood of using phage therapy. Moreover, the conjoint experiment reveals that success and side effect rate, treatment duration, and where the medicine has been approved for use has a statistically significant effect on participants' treatment preferences. Investigations altering the framing of phage therapy, to highlight positive and negative aspects, reveal a higher acceptance of the treatment when described without using perceived harsh words, such as "kill" and "virus". Combined, this information provides an initial insight into how phage therapy could be developed and introduced in the UK to maximise acceptance rate.