Date of Award

January 2021

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Lauretta E. Grau

Abstract

Background: Oral pre-exposure prophylaxis (PrEP) is a daily medication that can prevent HIV infection. PrEP may further support HIV prevention initiatives in Thailand, particularly as it becomes more accessible in the country’s government clinics and hospitals. While studies have explored perceptions of PrEP for at-risk people in Thailand, there has been limited investigation into Thai physicians’ opinions of and willingness to prescribe PrEP. Methods: Using convenience sampling, this cross-sectional study recruited 132 Thai physicians to complete an anonymous, online survey. The survey assessed physicians’ concerns about PrEP, experience with PrEP, and willingness to prescribe PrEP. Bivariate and multivariable logistic regressions were conducted to assess factors associated with willingness to prescribe. Results: The majority of the sample had heard of PrEP before the survey (81.1%) and were willing to prescribe it (68.2%), though a minority had experience prescribing (18.2%). Common concerns regarding PrEP included the potential for decreased condom use, antiretroviral resistance, inadequate patient compliance, medication side effects, and an increase in STIs. The most frequently reported barrier to prescribing was a lack of clinical knowledge of PrEP. In a multivariable model, believing that PrEP was essential for addressing the HIV epidemic (aOR=20.87; 95% CI=3.69-118.12) and being willing to attend continuing medical education on PrEP (aOR=9.46; 95% CI=3.27-27.36) were associated with significantly higher odds of being willing to prescribe PrEP. Conclusion: This is the first study to assess Thai physicians’ willingness to prescribe PrEP. While the majority of our sample expressed willingness to prescribe, our results indicate a need to strengthen and promote medical education on PrEP to improve physicians’ knowledge of the medication and confidence in its safety and effectiveness. Public health messaging should also address physicians’ concerns about risk compensation following PrEP initiation and should further emphasize the potential importance of PrEP in reducing HIV incidence in Thailand.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/01/2022

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