Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation
Background: In the United States, human immunodeficiency virus (HIV) remains a substantial public health issue. There is evidence that the use of antiretroviral medications such as pre-exposure prophylaxis (PrEP) can be a safe and effective primary prevention strategy to reduce new cases of HIV infe...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Georgia Southern University
2017-07-01
|
| Series: | Journal of the Georgia Public Health Association |
| Subjects: | |
| Online Access: | https://digitalcommons.georgiasouthern.edu/jgpha/vol7/iss1/4 |
| _version_ | 1819225279917195264 |
|---|---|
| author | Jessica Grippo Stacy Smallwood Katherine Pincura Tamara Wright William Mase |
| author_facet | Jessica Grippo Stacy Smallwood Katherine Pincura Tamara Wright William Mase |
| author_sort | Jessica Grippo |
| collection | DOAJ |
| description | Background: In the United States, human immunodeficiency virus (HIV) remains a substantial public health issue. There is evidence that the use of antiretroviral medications such as pre-exposure prophylaxis (PrEP) can be a safe and effective primary prevention strategy to reduce new cases of HIV infection. Provider practice behavior as it relates to prescribing PrEP and the potential impact on specific vulnerable populations needs increased attention. Few studies have evaluated the attitudes of physicians towards ethical issues related to prescribing PrEP. Methods: The purpose of the present literature review was to evaluate provider attitudes toward the ethics of prescribing PrEP for individuals at risk of acquiring HIV infection. Searches of the PubMed and Cochrane databases were conducted. Three reviewers independently assessed the relevance of articles and discarded those not directly related to the attitudes of physicians toward ethics of the cost, safety, and resource allocation of PrEP. A total of twenty-one articles were included in the review. Results: Provider attitudes and perceptions focused on three areas: resource allocation, cost, and safety or effectiveness of PrEP. Providers who were hesitant in prescribing PrEP were concerned with the availability of resources, patient adherence, risk of drug resistance, and toxicity. In the studies reviewed, few providers had prescribed PrEP; however, prescribing practices trended upward with time and awareness. Conclusions: Realization of the benefits of PrEP will require a utilitarian ethical approach to identifying the populations that will benefit most, monitoring for adverse effects, addressing costs, and educating and training providers to prescribe PrEP responsibly. Ensuring that PrEP fulfills its potential as part of a combination regimen for HIV prevention requires identification of additional evidence, education, support services, and resources that are needed, as well as the regulatory framework and cost scenarios for access to PrEP. Key words: HIV, pre-exposure prophylaxis, ethics, utilitarianism, PrEP, physician |
| first_indexed | 2024-12-23T10:07:05Z |
| format | Article |
| id | doaj.art-3dd1cc6e4bb647beb293d97dc05d01b2 |
| institution | Directory Open Access Journal |
| issn | 2471-9773 |
| language | English |
| last_indexed | 2024-12-23T10:07:05Z |
| publishDate | 2017-07-01 |
| publisher | Georgia Southern University |
| record_format | Article |
| series | Journal of the Georgia Public Health Association |
| spelling | doaj.art-3dd1cc6e4bb647beb293d97dc05d01b22022-12-21T17:51:03ZengGeorgia Southern UniversityJournal of the Georgia Public Health Association2471-97732017-07-017110.21633/jgpha.7.104Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource AllocationJessica GrippoStacy SmallwoodKatherine PincuraTamara WrightWilliam MaseBackground: In the United States, human immunodeficiency virus (HIV) remains a substantial public health issue. There is evidence that the use of antiretroviral medications such as pre-exposure prophylaxis (PrEP) can be a safe and effective primary prevention strategy to reduce new cases of HIV infection. Provider practice behavior as it relates to prescribing PrEP and the potential impact on specific vulnerable populations needs increased attention. Few studies have evaluated the attitudes of physicians towards ethical issues related to prescribing PrEP. Methods: The purpose of the present literature review was to evaluate provider attitudes toward the ethics of prescribing PrEP for individuals at risk of acquiring HIV infection. Searches of the PubMed and Cochrane databases were conducted. Three reviewers independently assessed the relevance of articles and discarded those not directly related to the attitudes of physicians toward ethics of the cost, safety, and resource allocation of PrEP. A total of twenty-one articles were included in the review. Results: Provider attitudes and perceptions focused on three areas: resource allocation, cost, and safety or effectiveness of PrEP. Providers who were hesitant in prescribing PrEP were concerned with the availability of resources, patient adherence, risk of drug resistance, and toxicity. In the studies reviewed, few providers had prescribed PrEP; however, prescribing practices trended upward with time and awareness. Conclusions: Realization of the benefits of PrEP will require a utilitarian ethical approach to identifying the populations that will benefit most, monitoring for adverse effects, addressing costs, and educating and training providers to prescribe PrEP responsibly. Ensuring that PrEP fulfills its potential as part of a combination regimen for HIV prevention requires identification of additional evidence, education, support services, and resources that are needed, as well as the regulatory framework and cost scenarios for access to PrEP. Key words: HIV, pre-exposure prophylaxis, ethics, utilitarianism, PrEP, physicianhttps://digitalcommons.georgiasouthern.edu/jgpha/vol7/iss1/4hivpre-exposure prophylaxisethicsutilitarianismprepphysician |
| spellingShingle | Jessica Grippo Stacy Smallwood Katherine Pincura Tamara Wright William Mase Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation Journal of the Georgia Public Health Association hiv pre-exposure prophylaxis ethics utilitarianism prep physician |
| title | Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation |
| title_full | Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation |
| title_fullStr | Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation |
| title_full_unstemmed | Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation |
| title_short | Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation |
| title_sort | physician attitudes toward the ethics of pre exposure prophylaxis prep cost safety and resource allocation |
| topic | hiv pre-exposure prophylaxis ethics utilitarianism prep physician |
| url | https://digitalcommons.georgiasouthern.edu/jgpha/vol7/iss1/4 |
| work_keys_str_mv | AT jessicagrippo physicianattitudestowardtheethicsofpreexposureprophylaxisprepcostsafetyandresourceallocation AT stacysmallwood physicianattitudestowardtheethicsofpreexposureprophylaxisprepcostsafetyandresourceallocation AT katherinepincura physicianattitudestowardtheethicsofpreexposureprophylaxisprepcostsafetyandresourceallocation AT tamarawright physicianattitudestowardtheethicsofpreexposureprophylaxisprepcostsafetyandresourceallocation AT williammase physicianattitudestowardtheethicsofpreexposureprophylaxisprepcostsafetyandresourceallocation |