P210: Risk Management Insights for Oral HIV-1 PrEP: Findings from Two-Wave Knowledge Surveys of Canadian PrEP Prescribers and Users
Poster Presenter
Soodi NAVADEH
Director
Gilead Sciences United States
Objectives
To identify knowledge gaps as part of ongoing risk-minimization efforts and to inform education initiatives, we evaluated knowledge, attitudes, and behaviors related to oral HIV-1 pre-exposure prophylaxis (PrEP) among Canadian healthcare providers (HCPs) and PrEP users.
Method
Two separate two-wave surveys assessing safe PrEP use were sent to HCPs who had prescribed oral PrEP and to PrEP users aged =18 years with oral PrEP use within past 30 days. The primary outcome was adequate PrEP knowledge, defined as =80% correct responses for HCPs and =75% for users.
Results
Across Wave 1 (December 2022?May 2023) and Wave 2 (March 2024?September 2024), 109 of 1257 invited HCPs and 138 of 1095 invited PrEP users completed the surveys. HCP respondents were primarily physicians (96%); most HCPs specialized in family medicine or general practice (73%), and approximately half were located in Ontario (51%). Most PrEP users identified as male (95%) and nearly all (99%) had at least a high school education; over two-thirds (69%) were employed full-time, and the majority resided in Ontario (70%).
Most HCPs (79%) had prescribed PrEP within the last month. Adequate PrEP knowledge was demonstrated by 72% of HCPs (correctly answered =11/14 true/false questions), with an overall average of 87% of correct responses. Questions most HCPs answered correctly concerned assessing creatinine clearance before starting oral PrEP (99%) and understanding the link between adherence to PrEP and effectiveness (99%). Fewer HCPs were aware that PrEP should be stopped in individuals with signs or symptoms of acute HIV-1 infection (64%) and that such individuals should begin an HIV-1 treatment regimen promptly (51%).
Among all PrEP users, 62% demonstrated adequate knowledge (correctly answered =9/12 true/false questions), with an overall average of 74% correct responses. Most PrEP users (94%) knew that a negative HIV-1 test is required before initiating PrEP, a critical safety step to avoid starting PrEP during acute infection. Fewer PrEP users were aware that a negative hepatitis B test is required before starting oral PrEP (54%) and that they should inform their HCP of any recent flu-like symptoms (60%). Only 62% of PrEP users correctly identified that condoms should continue to be used when taking oral PrEP.
Conclusion
Knowledge assessments are an important component of ensuring the appropriate use of oral PrEP. In Canada, educational materials for HCPs and PrEP users are available to explain safe and effective use, including managing the risk of HIV-1 acquisition due to nonadherence and the potential for resistance if PrEP is started or continued in unrecognized or acute HIV-1 infection. Evaluating the effectiveness of these risk-minimization measures in a real-world setting is crucial to identify gaps in knowledge and inform revisions of risk management strategies.
Most PrEP-prescribing Canadian HCPs were knowledgeable about PrEP and engaged in behaviors consistent with Canadian guidelines on PrEP, but some HCPs could benefit from additional education on healthcare management for people with signs or symptoms of acute HIV-1. Nearly two-thirds of Canadian PrEP users demonstrated adequate knowledge levels regarding oral PrEP use and risks. Although nearly all PrEP users understood that baseline HIV-1 testing was required prior to initiation, opportunities exist to help empower PrEP users to mitigate risks and manage their health by improving PrEP knowledge and behaviors regarding hepatitis B, acute HIV-1 infection symptoms, and condom use.
This systematic evaluation of knowledge across prescribers and users with real-world PrEP experience illustrates the value of survey data in providing insights that can be used to inform and prioritize risk-minimization strategies, including targeted education and structured risk communication. This work can serve as an educational case study illustrating how knowledge assessments can be used within a pharmacovigilance and risk management framework
