{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:31:19Z","timestamp":1765233079374,"version":"3.37.3"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T00:00:00Z","timestamp":1619654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin","doi-asserted-by":"publisher","award":["Open Access Publication Fund"],"award-info":[{"award-number":["Open Access Publication Fund"]}],"id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>German statutory health insurance began covering the costs associated with HIV PrEP in September 2019; however, to bill for PrEP services, physicians in Germany must either be certified as HIV-specialists according to a nationwide quality assurance agreement, or, if they are non-HIV-specialists, have completed substantial further training in HIV\/PrEP care. Given the insufficient implementation of PrEP, the aim of our study was to explore the potential to increase the number of non-HIV-specialists providing PrEP-related services.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted an anonymous survey among a random sample of internists, general practitioners, dermatologists and urologists throughout Germany using a self-developed questionnaire. We calculated a knowledge score and an attitudes score from individual items in these two domains. Both scores ranged from 0\u201320, with high values representing good knowledge or positive attitudes. We also asked participants about the proportion of PrEP advice they provided proactively to men who have sex with men (MSM) and trans-persons who met the criteria to be offered PrEP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>154 physicians completed the questionnaire. Self-assessed knowledge among HIV-specialists was greater than among non-HIV-specialists [<jats:italic>Median<\/jats:italic> knowledge score: 20.0 (<jats:italic>IQR<\/jats:italic> = 0.0) vs. 4.0 (<jats:italic>IQR<\/jats:italic> = 11.0), <jats:italic>p<\/jats:italic>&lt;0.001]. Likewise, attitudes towards PrEP were more positive among HIV-specialists than non-HIV-specialists [<jats:italic>Median<\/jats:italic> attitudes score: 18.0 (<jats:italic>IQR<\/jats:italic> = 3.0) vs. 13.0 (<jats:italic>IQR<\/jats:italic> = 5.25), <jats:italic>p<\/jats:italic>&lt;0.001]. The proportion of proactive advice on PrEP provided to at-risk MSM and trans-persons by HIV-specialists [<jats:italic>Median<\/jats:italic>: 30.0% (<jats:italic>IQR<\/jats:italic> = 63.5%)] was higher than that provided by non-HIV-specialists [<jats:italic>Median<\/jats:italic>: 0.0% (<jats:italic>IQR<\/jats:italic> = 11.3%), <jats:italic>p<\/jats:italic>&lt;0.001]. However, the results of our multiple regression suggest the only independent predictor of proactive PrEP advice was the knowledge score, and not whether physicians were HIV-specialists or non-HIV-specialists.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>These findings point to opportunities to improve PrEP implementation in individuals at risk of acquiring HIV. Targeted training, particularly for non-HIV-specialists, and the provision of patient-centered information material could help improve care, especially in rural areas.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250895","type":"journal-article","created":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T17:38:40Z","timestamp":1619717920000},"page":"e0250895","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["HIV Pre-exposure Prophylaxis (PrEP): Knowledge, attitudes and counseling practices among physicians in Germany \u2013 A cross-sectional survey"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3338-3891","authenticated-orcid":true,"given":"Mary Katherine","family":"Sammons","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6436-2703","authenticated-orcid":true,"given":"Matthew","family":"Gaskins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Kutscha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Nast","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3209-1392","authenticated-orcid":true,"given":"Ricardo Niklas","family":"Werner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,29]]},"reference":[{"issue":"27","key":"pone.0250895.ref001","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1056\/NEJMoa1011205","article-title":"Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men","volume":"363","author":"RM Grant","year":"2010","journal-title":"New Engl J Med"},{"issue":"4","key":"pone.0250895.ref002","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/QAI.0b013e3182801081","article-title":"The acceptability and feasibility of an HIV preexposure prophylaxis (PrEP) trial with young men who have sex with men","volume":"62","author":"SG Hosek","year":"2013","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"10013","key":"pone.0250895.ref003","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0140-6736(15)00056-2","article-title":"Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial","volume":"387","author":"S McCormack","year":"2016","journal-title":"Lancet (London, England)"},{"issue":"23","key":"pone.0250895.ref004","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1056\/NEJMoa1506273","article-title":"On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection","volume":"373","author":"JM Molina","year":"2015","journal-title":"The New England journal of medicine"},{"issue":"11","key":"pone.0250895.ref005","doi-asserted-by":"crossref","first-page":"E482","DOI":"10.1016\/S2352-3018(17)30181-9","article-title":"Rapidly declining HIV infection in MSM in central London","volume":"4","author":"N Nwokolo","year":"2017","journal-title":"Lancet Hiv"},{"key":"pone.0250895.ref006","unstructured":"San Francisco Department of Public Health\u2014HIV Epidemiology Section. 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