Table 3.
Univariable and multivariable logistic regression analyses of associations of potential predictors and nPEP prescription history among HIV medical care providers in China (n=777).
| Variable | nPEPa prescription | Crude model | Adjusted model | P value | ||||||||||||
|
|
Yes, n (%) | No (n, %) | ORb (95% CI) | aORc (95% CI) |
|
|||||||||||
| Age in years | ||||||||||||||||
|
|
<40 | 153 (50.2) | 152 (49.8) | Refd | —e | — | ||||||||||
|
|
40-49 | 179 (54.1) | 152 (45.9) | 1.17 (0.86-1.60) | — | — | ||||||||||
|
|
≥50 | 82 (58.2) | 59 (41.8) | 1.38 (0.92-2.07) | — | — | ||||||||||
| Ethnicity | ||||||||||||||||
|
|
Han | 374 (52.5) | 338 (47.5) | Ref | — | — | ||||||||||
|
|
Non-Han | 40 (61.5) | 25 (38.5) | 1.45 (0.86-2.43) | — | — | ||||||||||
| Sex | ||||||||||||||||
|
|
Female | 233 (55.9) | 184 (44.1) | Ref | — | — | ||||||||||
|
|
Male | 181 (50.3) | 179 (49.7) | 0.80 (0.60-1.06) | — | — | ||||||||||
| Educational background | ||||||||||||||||
|
|
Undergraduate or above | 400 (53.8) | 343 (46.2) | Ref | — | — | ||||||||||
|
|
Junior college | 13 (44.8) | 16 (55.2) | 0.61 (0.33-1.47) | — | — | ||||||||||
|
|
High school/technical secondary school | 1 (20.0) | 4 (80.0) | 0.21 (0.02-1.93) | — | — | ||||||||||
| Administrative regions of China | ||||||||||||||||
|
|
North | 45 (63.4) | 26 (36.6) | Ref | Ref | — | ||||||||||
|
|
Northeast | 76 (46.3) | 88 (53.7) | 0.50 (0.28-0.88) | 0.51 (0.28-0.91) | .02 | ||||||||||
|
|
East | 63 (54.3) | 53 (45.7) | 0.69 (0.38-1.26) | 0.71 (0.38-1.31) | .27 | ||||||||||
|
|
South Central | 113 (56.2) | 88 (43.8) | 0.74 (0.43-1.30) | 0.82 (0.46-1.45) | .49 | ||||||||||
|
|
Southwest | 107 (53.8) | 92 (46.2) | 0.67 (0.39-1.17) | 0.70 (0.40-1.23) | .22 | ||||||||||
|
|
Northwest | 10 (38.5) | 16 (61.5) | 0.36 (0.14-0.91) | 0.35 (0.14-0.89) | .03 | ||||||||||
| nPEP pilot provincef | ||||||||||||||||
|
|
No | 264 (51.8) | 246 (48.2) | Ref | Ref | — | ||||||||||
|
|
Yes | 150 (56.2) | 117 (43.8) | 1.20 (0.89-1.61) | 1.13 (0.82-1.58) | .46 | ||||||||||
| Local HIV epidemic levelg | ||||||||||||||||
|
|
Low | 60 (51.7) | 56 (48.3) | Ref | Ref | — | ||||||||||
|
|
Middle | 144 (56.3) | 112 (43.8) | 1.20 (0.77-1.86) | 1.45 (0.85-2.49) | .17 | ||||||||||
|
|
High | 210 (51.9) | 195 (48.1) | 1.01 (0.67-1.52) | 0.50 (0.24-1.03) | .06 | ||||||||||
| Hospital type | ||||||||||||||||
|
|
General hospital | 158 (41.3) | 225 (58.7) | Ref | Ref | — | ||||||||||
|
|
Specialized hospital for infectious diseases | 256 (65.0) | 138 (35.0) | 2.64 (1.98-3.53) | 2.49 (1.85-3.37) | <.001 | ||||||||||
| Technical title | ||||||||||||||||
|
|
General physician | 38 (46.3) | 44 (53.7) | Ref | Ref | — | ||||||||||
|
|
Attending physician | 141 (51.5) | 133 (48.5) | 1.23 (0.75-2.01) | 1.25 (0.75-2.07) | .40 | ||||||||||
|
|
Associate chief physician | 105 (47.5) | 116 (52.5) | 1.05 (0.63-1.74) | 0.98 (0.55-1.77) | .96 | ||||||||||
|
|
Chief physician | 130 (65.0) | 70 (35.0) | 2.15 (1.28-3.63) | 2.16 (1.15-4.05) | .02 | ||||||||||
| Clinical practice specialty | ||||||||||||||||
|
|
Non-HIV care professional | 26 (20.3) | 102 (79.7) | Ref | Ref | — | ||||||||||
|
|
HIV care professional | 388 (59.8) | 261 (40.2) | 5.83 (3.69-9.22) | 6.13 (3.83-9.81) | <.001 | ||||||||||
| Practice time in years | ||||||||||||||||
|
|
≤5 | 128 (37.1) | 217 (62.9) | Ref | Ref | — | ||||||||||
|
|
6-10 | 118 (64.1) | 66 (35.9) | 3.03 (2.09-4.40) | 3.28 (2.23-4.80) | <.001 | ||||||||||
|
|
≥11 | 168 (67.7) | 80 (32.3) | 3.56 (2.52-5.02) | 3.75 (2.59-5.45) | <.001 | ||||||||||
| Unfamiliar with oPEPh | ||||||||||||||||
|
|
No | 345 (71.1) | 140 (28.9) | Ref | Ref | — | ||||||||||
|
|
Yes | 69 (23.6) | 223 (76.4) | 0.13 (0.09-0.18) | 0.12 (0.08-0.16) | <.001 | ||||||||||
| Unfamiliar with nPEP | ||||||||||||||||
|
|
No | 264 (85.4) | 45 (14.6) | Ref | Ref | — | ||||||||||
|
|
Yes | 150 (32.1) | 318 (67.9) | 0.08 (0.06-0.12) | 0.08 (0.05-0.11) | <.001 | ||||||||||
| China has issued a national clinical guideline on nPEP | ||||||||||||||||
|
|
No | 115 (50.9) | 111 (49.1) | Ref | Ref | — | ||||||||||
|
|
Yes/ I don’t know | 299 (54.3) | 252 (45.7) | 0.04 (0.01-0.11) | 0.03 (0.01-0.09) | <.001 | ||||||||||
| UAIi risk between males exceeds percutaneous occupational exposure risk | ||||||||||||||||
|
|
Yes | 366 (54.9) | 301 (45.1) | Ref | Ref | — | ||||||||||
|
|
No/ I don’t know | 48 (43.6) | 62 (56.4) | 0.64 (0.42-0.96) | 0.63 (0.42-0.95) | .03 | ||||||||||
| Percutaneous occupational exposure risk exceeds UVIj exposure risk | ||||||||||||||||
|
|
Yes | 238 (44.7) | 294 (55.3) | Ref | Ref | — | ||||||||||
|
|
No/I don’t know | 176 (71.8) | 69 (28.2) | 3.15 (2.27-4.37) | 3.27 (2.33-4.58) | <.001 | ||||||||||
| Number of persons living with HIV in treatment in the past month | ||||||||||||||||
|
|
≤50 | 184 (39.9) | 277 (60.1) | Ref | Ref | — | ||||||||||
|
|
>50 | 230 (72.8) | 86 (27.2) | 4.03 (2.95-5.49) | 3.89 (2.83-5.36) | <.001 | ||||||||||
| Ever prescribed oPEP | ||||||||||||||||
|
|
No | 264 (45.5) | 316 (54.5) | Ref | Ref | — | ||||||||||
|
|
Yes | 150 (76.1) | 47 (23.9) | 3.82 (2.65-5.51) | 4.90 (3.29-7.29) | <.001 | ||||||||||
| Self-reported having a written oPEP guideline in place | ||||||||||||||||
|
|
Yes | 350 (60.9) | 225 (39.1) | Ref | Ref | — | ||||||||||
|
|
No | 56 (45.9) | 66 (54.1) | 0.55 (0.37-0.81) | 0.53 (0.35-0.79) | .002 | ||||||||||
|
|
Unsure | 8 (10.0) | 72 (90.0) | 0.07 (0.03-0.15) | 0.07 (0.03-0.15) | <.001 | ||||||||||
| Key populations seeking nPEP over the past 6 months | ||||||||||||||||
|
|
Never/rarely (<1/month) | 149 (32.0) | 316 (68.0) | Ref | Ref | — | ||||||||||
|
|
Often/occasionally (>1/month) | 265 (84.9) | 47 (15.1) | 11.96 (8.29-17.25) | 13.86 (9.42-20.39) | <.001 | ||||||||||
| nPEP-related attitudes | ||||||||||||||||
|
|
Adequate time to prescribe nPEP | |||||||||||||||
|
|
|
Disagree | 44 (52.4) | 40 (47.6) | Ref | Ref | — | |||||||||
|
|
|
Neutral | 109 (46.4) | 126 (53.6) | 0.79 (0.48-1.30) | 0.83 (0.50-1.38) | .47 | |||||||||
|
|
|
Agree | 261 (57.0) | 197 (43.0) | 1.20 (0.76-1.92) | 1.24 (0.77-2.00) | .38 | |||||||||
|
|
Feasible to provide nPEP in place | |||||||||||||||
|
|
|
Disagree | 3 (37.5) | 5 (62.5) | Ref | Ref | — | |||||||||
|
|
|
Neutral | 11 (19.3) | 46 (80.7) | 0.40 (0.08-1.93) | 0.42 (0.09-2.09) | .29 | |||||||||
|
|
|
Agree | 400 (56.2) | 312 (43.8) | 2.14 (0.51-9.01) | 2.20 (0.51-9.51) | .29 | |||||||||
|
|
nPEP will promote HIV drug resistance | |||||||||||||||
|
|
|
Disagree | 161 (62.6) | 96 (37.4) | Ref | Ref | — | |||||||||
|
|
|
Neutral | 157 (51.0) | 151 (49.0) | 0.62 (0.44-0.87) | 0.65 (0.46-0.92) | .014 | |||||||||
|
|
|
Agree | 96 (45.3) | 116 (54.7) | 0.49 (0.34-0.72) | 0.53 (0.36-0.77) | .001 | |||||||||
|
|
nPEP will promote HIV risky behavior | |||||||||||||||
|
|
|
Disagree | 137 (62.6) | 82 (37.4) | Ref | Ref | — | |||||||||
|
|
|
Neutral | 161 (53.3) | 141 (46.7) | 0.68 (0.48-0.98) | 0.69 (0.48-0.99) | .04 | |||||||||
|
|
|
Agree | 116 (45.3) | 140 (54.7) | 0.50 (0.34-0.72) | 0.53 (0.36-0.77) | .001 | |||||||||
|
|
Concern about prescribing nPEP | |||||||||||||||
|
|
|
No | 13 (54.2) | 11 (45.8) | Ref | Ref | — | |||||||||
|
|
|
Yes | 401 (53.3) | 352 (46.7) | 0.96 (0.43-2.18) | 0.97 (0.43-2.23) | .95 | |||||||||
|
|
Concern about promoting HIV high-risk behaviors |
|
||||||||||||||
|
|
|
No | 268 (55.1) | 218 (44.9) | Ref | Ref | — | |||||||||
|
|
|
Yes | 146 (50.2) | 145 (49.8) | 0.82 (0.61-1.10) | 0.83 (0.61-1.11) | .21 | |||||||||
|
|
Concern about poor adherence to nPEP |
|
||||||||||||||
|
|
|
No | 261 (55.9) | 206 (44.1) | Ref | Ref | — | |||||||||
|
|
|
Yes | 153 (49.4) | 157 (50.6) | 0.77 (0.58-1.03) | 0.81 (0.60-1.09) | .16 | |||||||||
|
|
Concern about HIV drug resistance |
|
||||||||||||||
|
|
|
No | 288 (53.4) | 251 (46.6) | Ref | Ref | — | |||||||||
|
|
|
Yes | 126 (52.9) | 112 (47.1) | 0.98 (0.72-1.33) | 0.97 (0.71-1.32) | .83 | |||||||||
|
|
Concern about side effects of drugs |
|
||||||||||||||
|
|
|
No | 181 (53.4) | 158 (46.6) | Ref | Ref | — | |||||||||
|
|
|
Yes | 233 (53.2) | 205 (46.8) | 0.99 (0.75-1.32) | 0.98 (0.73-1.31) | .88 | |||||||||
|
|
Concern about cost of nPEP |
|
||||||||||||||
|
|
|
No | 158 (48.6) | 167 (51.4) | Ref | Ref | — | |||||||||
|
|
|
Yes | 256 (56.6) | 196 (43.4) | 1.38 (1.04-1.84) | 1.39 (1.03-1.86) | .03 | |||||||||
|
|
Concern about lack of nPEP clinical guideline |
|
||||||||||||||
|
|
|
No | 326 (52.8) | 292 (47.2) | Ref | Ref | — | |||||||||
|
|
|
Yes | 88 (55.3) | 71 (44.7) | 1.11 (0.78-1.58) | 1.19 (0.83-1.71) | .34 | |||||||||
|
|
Concern about lack of drug indications |
|
||||||||||||||
|
|
|
No | 338 (51.9) | 313 (48.1) | Ref | Ref | — | |||||||||
|
|
|
Yes | 76 (60.3) | 50 (39.7) | 1.41 (0.95-2.08) | 1.50 (1.01-2.24) | .045 | |||||||||
|
|
Concern about reducing treatment resources of HIV-positive patients |
|
||||||||||||||
|
|
|
No | 377 (57.5) | 279 (42.5) | Ref | Ref | — | |||||||||
|
|
|
Yes | 37 (30.6) | 84 (69.4) | 0.33 (0.22-0.50) | 0.32 (0.21-0.49) | <.001 | |||||||||
anPEP: nonoccupational postexposure prophylaxis.
bOR: odds ratio.
caOR: adjusted odds ratio.
dRef: reference.
eN/A: not applicable.
fnPEP pilot programs were conducted by China CDC in provinces Yunnan, Beijing, Tianjin, Heilongjiang, Hunan, Guangxi, and Guizhou.
gLocal HIV epidemic level was categorized according to the number of HIV/AIDS cases reported in 2017.
hoPEP: occupational postexposure prophylaxis.
iUAI: unprotected anal intercourse.
jUVI: unprotected vaginal intercourse.