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Primary Care Providers Have Limited Knowledge About STI Screening And HIV PrEP in Men Who have Sex with Men - Training Did Not Improve Provider Knowledge of STIs and PrEP for MSM
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Training Did Not Improve Provider Knowledge of STIs and PrEP for MSM
IDWeek2017/IDSA, October 4-8, 2017, San Diego
Mark Mascolini
Providers at a New England academic medical center correctly answered only half of questions about sexually transmitted infection (STI) screening and preexposure prophylaxis (PrEP) in men who have sex with men (MSM), according to results of an email survey [1]. Knowledge of these issues proved low regardless of whether providers received training in caring for MSM or managing STIs.
Researchers at Baystate Medical Center, an academic center in Springfield, Massachusetts, conducted an email survey of the center's primary care providers to find ways to improve knowledge of STI screening and PrEP use in MSM in their health care system. In February to April, 2016, they emailed Baystate providers a link to an online survey posing questions about training, CDC STI screening recommendations, and PrEP. Respondents had a chance to enter a raffle for a $25 gift card. Nonrespondents got three follow-up reminders. The survey closed 2 weeks after the last reminder. A hyperlink at the end of the questionnaire took users to CDC MSM STI screening recommendations.
Of the 314 providers sent email, 109 (35%) completed the survey. Resident physicians constituted the largest proportion of respondents (49%), followed by attending physicians (40%) and nurses and physician assistants (PAs) (11%). Age of all respondents averaged 38.1 years and years in practice 8.6. Three quarters of providers (77.1%) had specific training in treating STIs, while one third (35%) reported training in caring for MSM and two thirds (66.7%) actually cared for MSM.
More than half of respondents (54.1%) "often" or "always" asked patients about sexual practices, while 35.8% sometimes asked and the rest rarely or never asked. Among providers who cared for MSM, 50% "often" or "always" asked about sexual practice, while 33% did sometimes and the rest rarely or never. In this group of 72 MSM providers, only 2 (2.8%) discussed PrEP with all MSM in the last year, 6 (8.3%) discussed PrEP with most MSM, 3 (4.2%) discussed it with some MSM, and the rest talked about PrEP with few or no MSM or did not respond to this question.
Overall, providers answered only 49% of the STI or PrEP questions correctly (range 0% to 100%), and the correct response rate did not vary considerably between attending physicians, residents, or nurse/PAs. Nor did the right-answer rate differ much between providers who did or did not have MSM training (49% versus 48%, P = 0.87) or did or did not have STI training (51% versus 41%, P = 0.14). Among 29 providers who discussed PrEP with MSM at least once, 13 (45%) correctly answered the MSM PrEP indication question, compared with 8 (28%) of those who did not discuss PrEP.
While about 70% of providers knew that MSM run an increased risk of STIs, only about 50% knew (1) correct testing indications for drug users, (2) urethral testing recommendations, or (3) guidelines for annual HIV or syphilis testing. Only about 40% knew rectal test recommendations, 30% pharyngeal testing guidelines, and 25% PrEP indications.
The Baystate team concluded that primary care provider "knowledge of STI screening guidelines and PrEP indications for MSM is low, even among [providers] who reported receiving MSM-specific training." Still, they called for more training on these topics because PrEP can reduce HIV transmission while increasing STI rates.
Reference
1. Walker D, Friderici J, Skiest D. Primary care providers have limited knowledge about STI screening and HIV PrEP in men who have sex with men. IDWeek2017/IDSA. October 4-8, 2017. San Diego. Abstract 2252.
Durane Walker MD, Jennifer Friderici MS, Daniel Skiest MD
Baystate Medical Center/UMMS
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