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Post exposure prophylaxis (PEP) for HIV infection has been shown to significantly reduce the transmission of HIV in both occupational exposures and vertical transmission; however, its role in non-occupational sexual exposures has been harder to define.1,2 In 1988 the New South Wales (NSW) health department released guidelines for PEP use in non-occupational exposures, including sexual exposures, based on recommendations from the Centre for Disease Control and Prevention.3,4 Eligibility depends upon risk, time since exposure and negotiated risk versus benefit.3,4
In Sydney, campaigns raising awareness of PEP have focused on the gay community, impacting upon inner city GPs with higher numbers of HIV positive clients. Little is known about the experience or knowledge of HIV PEP among GPs who do not practise in areas of higher HIV prevalence and have lower or no HIV case loads. GP studies have shown that limited HIV experience and training may affect the ability to effectively assess, advise, and treat patients.5,6
We focused on GPs in northern Sydney, an area that comprises approximately 12% of the NSW population. From March to July 2002 a questionnaire was submitted to GPs from the northern suburbs of Sydney via mailout and also distributed at regular GP education meetings. We collected demographic information and GPs were asked what they knew about the availability of HIV PEP, its uses, prescribing time restrictions, and access.
We received 202 GP responses in total: 162 from education sessions, a 68.6% response rate, and 40 responses from the mailout questionnaire, a 6.2% response rate. Most respondents were female (114/202, 56.2%). Women were generally younger (median age: 46 years, range: 28–71 years) and were more likely to work part time (67/114, 58.7%) compared to their male counterparts (median age 54 years, range 27–86 years. Full time work: 65/85, 81.3%).
While 68.5% (139/202) of those surveyed were aware of the availability of HIV PEP for high risk occupational exposures, only half of those (69/139), or 35.1% of all doctors (71/202: p<0.0001) were aware of the availability of HIV PEP for sexual exposures. Of all surveyed, 24.6% (50/202) were aware of the 72 hour time restrictions with 28.1% (56/202) offering explanations of how to access HIV PEP. Of doctors aware of the availability of HIV PEP for sexual exposures, 42.3% (30/71: p<0.0001) were aware of time restrictions with 46.5% (33/71: p<0.0001) offering explanations of access.
Low levels of awareness and knowledge of HIV PEP may translate to missed opportunities for access to PEP, and potential HIV infection. Limited knowledge may reflect the recent introduction of PEP into Australia and/or unfamiliarity with HIV infection and patients. Limitations of this study include the small sample of self selected doctors who, it may be argued, were more motivated learners, or more interested in HIV PEP. Education aimed at increasing GP awareness of basic HIV PEP principles may be beneficial for those in low HIV caseload areas for patients missed by campaigns targeted at high risk communities.