Knowledge, Perceptions, and Practices of Primary Care Physicians on HIV and PrEP: Challenges and Principles of PrEP Use

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Can you provide more background on current knowledge about HIV diagnostics reimbursement to primary care physicians? What policy surrounds HIV diagnostics and testing in Poland? Are physicians required to order HIV tests for at-risk patients?

After the recent increase in HIV infection, was there any training to physicians on PREP, HIV Counseling and Testing, need for HIV testing, how to conduct rapid testing? Were there collaborations or advocacy among physicians/healthcare providers, the Ministry of Health, and relevant government agencies? Kindly indicate 

Are there other barriers limiting PREP uptake?

In figure 5, can clarify PREP dosage for men, is the dosage the same for cisgender and transgender men? Does exposure or risk category have any effect on dosage?

Author Response

Comment 1: Can you provide more background on current knowledge about HIV diagnostics reimbursement to primary care physicians? What policy surrounds HIV diagnostics and testing in Poland? Are physicians required to order HIV tests for at-risk patients?

The answer: Dear reviewer, thank you for all the comments. I added more information about this topics in the "introduction".

Comment 2: After the recent increase in HIV infection, was there any training to physicians on PREP, HIV Counseling and Testing, need for HIV testing, how to conduct rapid testing? Were there collaborations or advocacy among physicians/healthcare providers, the Ministry of Health, and relevant government agencies? Kindly indicate 

The answer: In Poland, there is a lack of training in knowledge of HIV and AIDS, including methods of diagnosis, use of PreP, or testing for doctors working in primary health care institutions. Greater involvement from the Ministry of Health and integration into national healthcare policies would enhance education and advocacy efforts, addressing the current gaps in physician knowledge and collaboration for HIV prevention and testing. I wrote about it in discussion and conclusion. 

Comment 3: Are there other barriers limiting PREP uptake?

The answer: There are certainly many barriers to the use of prep, such as costs, discrimination, etc., but in this paper I want to focus only on the limitations related to the doctors themselves. There is small paragraph in the discussion about the costs. 

Comment 4: In figure 5, can clarify PREP dosage for men, is the dosage the same for cisgender and transgender men? Does exposure or risk category have any effect on dosage?

The answer: I changed figure 5. Exposure and risk group affect continuous or on-demand dosing. Does not affect the dose of the drug according to PTN AIDS 2024 guidelines.

                                                             

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

I appreciate your hard work on this study and look forward to seeing the final version.

1. Please explain how you calculated the significant number of participants to make the data representative of the Polish HCP.
2. I would appreciate it if you added a paragraph comparing your results with recent studies globally.

Thanks and good luck

Comments on the Quality of English Language

Hi,

There are minor linguistic typos in need of being corrected; please revise the manuscript language-wise.

Author Response

Comment 1: Please explain how you calculated the significant number of participants to make the data representative of the Polish HCP.

Response 1: Dear Editor, thank you for all the comments. I added information about it in "materials and methods" - "

The representativeness of the study group regarding the length of professional experience was analysed, showing that most experience-length classes were proportionally represented compared to population-based expectations. Confidence intervals for proportions were calculated using the `binom.confint` function from the R package "binom" for a sample size of n=100. The data was collected from databases made available by the Polish Central Statistical Office and the Polish General Medical Council for the year 2023. 

For the class <1 year, the observed proportion was 7%, with a confidence interval of 3.43%–13.75%, which does not include the expected proportion of 2%. This indicates overrepresentation of this group in the study sample. For the remaining classes of experience length, namely 1–5 years, 6–10 years, and >10 years, the observed proportions fell within the determined confidence intervals, reflecting consistency with population data."

Comment 2: I would appreciate it if you added a paragraph comparing your results with recent studies globally.

Response 2: Dear Editor, thank you for the comment. As the study group is small and only one variable came out statistically significant, I think it would be ‘ excessive’ to compare the data with world data - studies on a larger group are needed for this purpose. 

Reviewer 3 Report

Comments and Suggestions for Authors

GENERAL

• My main concern is regarding the discrepancy between the title and purpose and the general content. The title and purpose limit the main topic on “knowledge” but the general contents, especially in the discussion section, also included “perception” and “practice”.

           

TITLE

• The title uses 2 sentences, which is unusual. I suggest the author change this title to 1 sentence only

ABSTRACT

• Results: How many subjects were initially contacted?
• Conclusion: The written conclusion does not have a relationship with the primary purpose of the study

KEYWORDS

• I suggest the addition of “knowledge”

INTRODUCTION

• Is there any previous data regarding this “knowledge” of the physicians?
•  

MATERIAL AND METHODS

• The survey material also included “practices, awareness, recommendation, and motivation”. The survey also asked “whether physicians perform” and “willingness”. I consider all of those things are not knowledge. Maybe the author could adjust the title if these issues are also part of this study.
• How many subjects were targeted in the beginning?
• What were the inclusion and exclusion criteria of the subjects?
• Line 123-127: Was this part of “results” ?

RESULTS

• How many surveys or questionnaires have already been distributed?
• How was the geographical distribution of the subjects?
• In the results, there were “recommends” which were not “knowledge”

DISCUSSION

• Was there any previous data from Poland regarding the same topic?
• There were “Recommendations for primary care physicians” in the paper. Was this the consequence of the results and discussion? Or was this a separate section? I consider this part to be unrelated to this paper. Maybe the author can add additional sentences in the introduction regarding this part or modify this part in the discussion. However, if this was the study's important message, the author must address it in the previous part.

TABLES

• Table 1: The title should be above the table itself
• Table 1: I am not sure whether the table is the correct form of this information

FIGURES

• Figure 1:  There were 4 parts in the figure but only 2 in the legend

Author Response

Comment 1: My main concern is regarding the discrepancy between the title and purpose and the general content. The title and purpose limit the main topic on “knowledge” but the general contents, especially in the discussion section, also included “perception” and “practice”. The title uses 2 sentences, which is unusual. I suggest the author change this title to 1 sentence only

Response 1: Dear Editor, thank you for all the comments.
I changed the title according to your suggestions, but it's difficult to shorten the tittle to one sentence. I am curious as to whether you think the new title is correct. 

Comment 2: How many subjects were initially contacted?

Response 2: As I wrote in "results" it's difficult to calculate how many subjects were initially contacted. Cited "However, since the electronic survey was distributed across several PHC facilities, it is challenging to determine the precise number of individuals who had access to the form compared to the number who actually responded. "

Comment 3: The written conclusion does not have a relationship with the primary purpose of the study

Response 3: I changed a bit the conclusion. 

Comment 4: Keywords.I suggest the addition of “knowledge”

Response 4: I added, thank you for the suggestion. 

Comment 5: Introduction. Is there any previous data regarding this “knowledge” of the physicians?

Response 5: I haven't found similar data on polish population. 

Comment 6: Material and methods. The survey material also included “practices, awareness, recommendation, and motivation”. The survey also asked “whether physicians perform” and “willingness”. I consider all of those things are not knowledge. Maybe the author could adjust the title if these issues are also part of this study.

Response 6: I changed the title. 

Comment 7: How many subjects were targeted in the beginning?

Response 7: As I wrote in "results" it's difficult to calculate how many subjects were initially contacted. Cited "However, since the electronic survey was distributed across several PHC facilities, it is challenging to determine the precise number of individuals who had access to the form compared to the number who actually responded. "

Comment 8: What were the inclusion and exclusion criteria of the subjects?

Response 8: There were no exclusion criteria for healthcare providers. Any doctor working in the PHC (except infectious diseases doctors) could participate in the study. 

Comment 9: Line 123-127: Was this part of “results” ?

Response 9: Is that the sample is representative of the Polish population in terms of the age of doctors. I have added this information to the materials and methods. I can changed it. Please give me information, what do you think about it. 

Comment 10: Results. How many surveys or questionnaires have already been distributed?

Response 10: As I wrote in "results" it's difficult to calculate how many subjects were initially contacted. Cited "However, since the electronic survey was distributed across several PHC facilities, it is challenging to determine the precise number of individuals who had access to the form compared to the number who actually responded. "

Comment 11: How was the geographical distribution of the subjects?

Response 11: The information about it is written in the section "materials and methods". Cited "The study primarily focused on the Lower Silesian Voivodeship, particularly Wroclaw, as well as the Lubusz Voivodeship, mainly Zielona Góra, and the Greater Poland and West Pomeranian Voivodeships. The collected data, both in paper and electronic format, were subsequently subjected to statistical analysis."

Comment 12: In the results, there were “recommends” which were not “knowledge”.

Response 12: I don't understand the comment. 

Comment 13: Was there any previous data from Poland regarding the same topic?

Response 13: I haven't found similar data. 

Comment 14: There were “Recommendations for primary care physicians” in the paper. Was this the consequence of the results and discussion? Or was this a separate section? I consider this part to be unrelated to this paper. Maybe the author can add additional sentences in the introduction regarding this part or modify this part in the discussion. However, if this was the study's important message, the author must address it in the previous part.

Response 14: I would like the paper to be an ‘information bulletin’ for GPs on how they can prescribe PrEP to patients. These recommendations are a ‘response’ to the results of the survey - lack of knowledge about prep and infrequent prescribing of this form of prophylaxis to patients. I would like this article to make it easier for doctors to access knowledge on this subject.  

Comment 15: Table 1: The title should be above the table itself

Response 15: Changed. 

Comment 16: Table 1: I am not sure whether the table is the correct form of this information

Response 16: Could you please elaborate on your comment? What exactly is unclear?

Comment 17: Figure 1:  There were 4 parts in the figure but only 2 in the legend

Response 17: Changed. 

Reviewer 4 Report

Comments and Suggestions for Authors

Review of Manuscript- Healthcare-3463490

 

AIM of study:

The aim of this study was to assess the knowledge of primary care physicians regarding symptoms suggestive of HIV infection, its diagnostics, and their familiarity with PrEP. Additionally, the article outlines the principles of PrEP use that can be applied in everyday medical practice.

 

 

In general, the manuscript is well-written except with minor errors below:

 

Materials and Methods.

lines 109-113: The authors stated: “The chi-square test (χ.) of independence was applied to assess the relationships between categorical variables. The null hypothesis of no association between variables was rejected at a significance level of p < 0.05. When expected frequencies in contingency tables were less than 5, Yates’ continuity correction or Fisher's exact test was used”. However, these were done minimally, and authors did not state why? Additionally, the authors needed to state what are the categorical variables, how they were measured in relation to existing studies. This information may have given more content to the manuscript. The use of a table to present more detailed analysis would boost the knowledge and understanding of the analysis by any reader.

 

The authors needed to provide more information on the population of Primary Healthcare Centres [PHCs] in the study locality, how the sample was selected for both paper survey and online. More importantly, the sample was small for a more detailed analysis. How many sections were in the survey and what did they address? If the survey was in English or Polish. How was the translation done? I suggest the authors add the questionnaire used in both languages because analysis was done using IBM SPSS statistics 26.0.

 

In general, this section is missing crucial information.

 

Results.

 

Lines 210-212: Most [to replace the majority] of physicians (72%) expressed a willingness to perform a rapid HIV cassette test in the primary care setting; however, due to the unavailability of such tests, they had no opportunity to conduct them.

 

Line 252-254: A lack of knowledge about what and where Voluntary Counselling and Testing Centres (VCTs) are, as well as limited awareness of pre-exposure prophylaxis (PrEP), were [to replace was] also more common in this group of more experienced physicians.

 

Lines 358-362: The authors also needed to discuss Table 1 and Figure 5. Workflow, own elaboration. And the workflow does not include the 1-month follow up before the subsequent visits every 3 months.

 

Formatting: I suggest the authors either use double spacing or indent the paragraphs without double spacing.

Author Response

Comment 1: Materials and Methods. Lines 109-113: The authors stated: “The chi-square test (χ.) of independence was applied to assess the relationships between categorical variables. The null hypothesis of no association between variables was rejected at a significance level of p < 0.05. When expected frequencies in contingency tables were less than 5, Yates’ continuity correction or Fisher's exact test was used”. However, these were done minimally, and authors did not state why? Additionally, the authors needed to state what are the categorical variables, how they were measured in relation to existing studies. This information may have given more content to the manuscript. The use of a table to present more detailed analysis would boost the knowledge and understanding of the analysis by any reader.

Response 1: Dear Editor, thank you for all the comments. I added more information in the paragraph "materials and methods". I wrote this paragraph according to the information received from statistician. Please, inform me if now it's ok, or should I still give more information.

Comment 2: The authors needed to provide more information on the population of Primary Healthcare Centres [PHCs] in the study locality, how the sample was selected for both paper survey and online. More importantly, the sample was small for a more detailed analysis. How many sections were in the survey and what did they address? If the survey was in English or Polish. How was the translation done? I suggest the authors add the questionnaire used in both languages because analysis was done using IBM SPSS statistics 26.0. 

Response 2: I added more information. 

Comment 3: Results.Lines 210-212: Most [to replace the majority] of physicians (72%) expressed a willingness to perform a rapid HIV cassette test in the primary care setting; however, due to the unavailability of such tests, they had no opportunity to conduct them.

Response 3: Changed.

Comment 4: Line 252-254: A lack of knowledge about what and where Voluntary Counselling and Testing Centres (VCTs) are, as well as limited awareness of pre-exposure prophylaxis (PrEP), were [to replace was] also more common in this group of more experienced physicians.

Response 4: Changed.

Comment 5: Lines 358-362: The authors also needed to discuss Table 1 and Figure 5. Workflow, own elaboration. And the workflow does not include the 1-month follow up before the subsequent visits every 3 months.

Response 5: The workflow does include the mentioned information.

Comment 6:  I suggest the authors either use double spacing or indent the paragraphs without double spacing.

Response 6: As far as I know, it will be edited by the magazine? Please give me information about this.