Academic Detailing to Increase Prescribing of HIV Pre-exposure Prophylaxis

Abstract

Although HIV pre-exposure prophylaxis can decrease new cases of HIV by up to 99%, many patients who could benefit from pre-exposure prophylaxis never receive prescriptions for it. Because pre-exposure prophylaxis is indicated for patients who do not have an infectious disease, increasing pre-exposure prophylaxis prescribing by primary care and generalist clinicians represents a key element of the Ending the HIV Epidemic in the U.S. initiative. This review provides an overview of academic detailing and how it is currently being used to increase pre-exposure prophylaxis prescribing. Academic detailing is outreach education that engages with clinicians in 1-to-1 or small group interactions focused on identifying and addressing an individual clinician's needs to increase their use of evidence-based practices. Academic detailing has been proven in multiple previous research studies, and the principles required for successful implementation include interactivity, clinical relevance of content, and focus on defined behavior change objectives. Clinician barriers to pre-exposure prophylaxis prescribing may occur in the domains of knowledge, attitudes, or behavior, and academic detailing has the potential to address all of these areas. State and local health departments have developed academic detailing programs focused on pre-exposure prophylaxis prescribing and other elements of HIV prevention-sometimes describing the approach as public health detailing. Few studies of academic detailing for preexposure prophylaxis have been published to date; rigorous evaluation of HIV-specific adaptations and innovations of the approach would represent an important contribution. In the setting of the COVID-19 pandemic, interest in virtual delivery of academic detailing has grown, which could inform efforts to implement academic detailing in rural communities and other underserved areas. Increasing this capacity could make an important contribution to Ending the HIV Epidemic in the U.S. and other HIV prevention efforts.

Influence of physician networks on the implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia

“…First, our findings demonstrated prescribers who had a greater number of SUD clients were more likely to initiate PSS, suggesting these clinicians may have had greater awareness of announcements related to innovations in SUD care. Prescribers with smaller SUD client loads therefore may be harder to reach with passive dissemination strategies such as online educational materials and didactic lectures to learn about new clinical guidance and may require more active dissemination strategies such as academic detailing [ 24 , 25 ] or interactive educational meetings [ 8 ].…”

“…SNA can be used to pilot test the feasibility of an implementation [ 21 ]; design communication strategies [ 22 ] tailoring dissemination to opinion leaders, network isolates, and other prescribers with few clinical contacts; and evaluate implementation efforts [ 23 ]. Health administrative data can be used with SNA to model physicians’ social networks, creating opportunities to evaluate and inform the implementation and diffusion of new policies and interventions on a population level [ 24 , 25 ]. Previous research on diffusion of new policies has shown the influence of networks on tobacco regulations among countries [ 26 ].…”

Provider Implicit Bias in Prescribing HIV Pre-exposure Prophylaxis (PrEP) to People Who Inject Drugs

“…Research suggests 43 that implicit bias can be changed with deliberate effort, at least in the short term. For instance, academic detailing 44 is one of the evidence-based outreach education strategies successfully used to support the scale-up of PrEP and target HIV and substance use–related biases. Considering the high burden of substance use disorders in the USA, it is critical to develop and implement effective strategies to prevent PCPs’ bias from negatively affecting clinical outcomes or contributing to health disparities among PWID.…”

A Clinical Guide to Support the Implementation of Addiction Consult Services and the Value of Teaching and Technical Assistance

“…Academic detailing 13 and practice facilitation 14 are other interactive and supportive implementation strategies that can assist with provision of substance use care 13 . Academic detailing is more focused on individual behavior change and uses a 1:1 strategy or small groups 13 ; thus, it may not be well suited for large-scale change such as implementing a new multidisciplinary service. Similar to TTA, practice facilitation addresses gaps, integrates care, increases adoption and acceptance, and builds capacity; however, practice facilitation includes formal goal setting and continuous improvement tools, which can be potentially more useful when growing or improving an existing intervention 14 .…”

“…In addition, the individual support and building of a peer network likely would not have been matched by publicly available resources alone. Academic detailing 13 and practice facilitation 14 are other interactive and supportive implementation strategies that can assist with provision of substance use care 13 . Academic detailing is more focused on individual behavior change and uses a 1:1 strategy or small groups 13 ; thus, it may not be well suited for large-scale change such as implementing a new multidisciplinary service.…”