Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US

Leech, Ashley A.; Christiansen, Cindy L.; Linas, Benjamin P.; Jacobsen, Donna M.; Morin, Isabel; Drainoni, Mari-Lynn

doi:10.1371/journal.pone.0238375

Cited by 11 publications

(10 citation statements)

References 23 publications

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“…Family physicians in our study differed, however, in their views on FPs' engagement in starting clients on PrEP and in providing follow-up care. Where previous quantitative studies mainly explored whether FPs would be willing to prescribe PrEP, our study thus provides a deeper understanding of their preferred degree of involvement in PrEP care ( 16 , 31 , 32 ). One central aspect that may influence such preferences, is preserving an acceptable cost-benefit balance in the FP practice.…”

Section: Discussionmentioning

confidence: 99%

How Do Family Physicians Perceive Their Role in Providing Pre-exposure Prophylaxis for HIV Prevention?–An Online Qualitative Study in Flanders, Belgium

et al. 2022

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Introduction:In Belgium, the provision of pre-exposure prophylaxis (PrEP) for HIV prevention is centralized in specialized HIV clinics. Engaging family physicians in PrEP care could help scale-up its delivery and reach underserved populations. The objective of this study was to gain insight into family physicians' self-perceived roles in providing PrEP.MethodsWe conducted 16 online group discussions with a total of 105 Flemish family physicians, between November 2020 and February 2021. A brief online questionnaire assessed their socio-demographics and experience with sexual health. We analyzed verbatim transcribed data using a grounded theory approach.ResultsDespite limited awareness and experience, participants reported a high willingness to be more actively involved in PrEP care. Four potential roles for the family physician in PrEP care were identified: acting as low-threshold entry point for advice; opportunistic case finding of PrEP candidates; initiating appropriate care for PrEP-eligible clients; and ensuring high-quality follow-up care for PrEP users. Participants framed each of these roles within their current activities and responsibilities as primary care providers. Yet, participants differed in their views on the concrete operationalization of these roles, and in the extent of their involvement in PrEP. Particular challenges were a lack of experience with antiretrovirals, perceived limited exposure to clients at high HIV risk, and a lack of expertise and resources to conduct time-intensive risk assessments and counseling related to PrEP.ConclusionBelgian family physicians demonstrated a keen willingness to be involved in PrEP care, but had differing views on the practical implementation into their practices. Providing tailored training on sexual health and PrEP, and investing in collaboration between primary and secondary care, could optimize the integration of PrEP in the primary care practice.

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Section: Discussionmentioning

confidence: 99%

How Do Family Physicians Perceive Their Role in Providing Pre-exposure Prophylaxis for HIV Prevention?–An Online Qualitative Study in Flanders, Belgium

et al. 2022

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“…HIV specialists are often seen as the experts in PrEP, but their focus is generally on individuals already living with HIV and they are not as likely to interact with HIV-negative individuals. [12][13][14] NPs in primary care are uniquely positioned to meet the challenge of providing PrEP to individuals. Not only are there more primary care providers compared with HIV specialists, but the number of visits individuals have with their primary care providers further reinforces that primary care is the best source of PrEP for most individuals.…”

Section: Introductionmentioning

confidence: 99%

“…Not only are there more primary care providers compared with HIV specialists, but the number of visits individuals have with their primary care providers further reinforces that primary care is the best source of PrEP for most individuals. 12 NPs in primary care settings are essential to increasing PrEP use among those at risk of HIV acquisition. The next two sections outline a plan to decrease barriers and provide a step-by-step approach to initiating PrEP in the primary care setting.…”

Section: Introductionmentioning

confidence: 99%

Implementing Pre-exposure Prophylactic Therapy in Primary Care

Custer¹,

Herbert²

2022

The Journal for Nurse Practitioners

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“…A critical lack of PCPs who prescribe PrEP exists (Chan et al, 2020;Leech et al, 2020). Many PCPs refer their patients to infectious disease (ID) providers or worse yet, they do not screen for HIV and PrEP need and thus, do not make referrals to ID providers (Mayer et al, 2020).…”

Section: Summary Of Studymentioning

confidence: 99%

“…While PCPs lack of commitment to prescribing PrEP can be attributed to several factors, PCPs have most frequently identified a lack of knowledge about PrEP prescribing and concerns about insurance coverage for PrEP as two of the largest barriers to PrEP prescribing (Leech et al, 2020;Patel et al, 2018;Petroll et al, 2017). While research has focused on barriers and facilitators to PrEP prescribing from the patient perspective, few studies have examined this phenomenon from the perspective of PCPs, highlighting the need for such studies (Leech et al, 2020).…”

Section: Summary Of Studymentioning

confidence: 99%

Primary care provider prep prescribing practices : southern United States

Traylor¹

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The Southern United States (U.S.) accounts for more than half of new HIV cases annually and African Americans make up the majority of new HIV diagnoses in this region. Pre-Exposure Prophylaxis (PrEP) is an effective biomedical HIV prevention strategy that is underutilized. Few studies have examined the PrEP prescribing practices of primary care providers (PCPs), particularly in the Southern U.S. This cross-sectional survey, driven by the Transtheoretical Model (TTM), examined the prescribing practices of Southern U.S. PCPs. Relationships between PCPs personal and practice variables were examined, together with TTM decisional balance variables. Participants (n=223) who had more African American patients in their practice were more likely to be in a higher TTM stage of change (p = .002) and were more likely to have written a PrEP prescription (p = .001). Access to PrEP resources (OR = 1.85, p = .001), streamlined insurance prior authorization processes (OR = 1.52, p = .010), working with staff who have PrEP knowledge (OR = 1.51, p = .033), having PrEP training (OR = 40.26, p < .001) and having patients who are motivated to take PrEP (OR = 2.19, p = .007) were significant facilitators to PrEP prescribing. Significant barriers to PrEP prescribing included a lack of provider PrEP training (OR = 0.43, p = .003), lack of clinical leadership regarding PrEP (OR = 0.65, p = .018), lack of insurance (OR = 2.74, p = .002), and likelihood of low patient adherence to PrEP (OR = 0.53, p = .001). Findings indicate that this sample of PCPs were more likely to be at a higher TTM stage of change and have written a PrEP prescription if they saw more African American patients in their practice. Further, significant facilitators of PrEP prescribing included access to PrEP resources, streamlined insurance prior authorization processes, working with staff who have PrEP knowledge, having PrEP training, and having patients who are motivated to take PrEP. Significant barriers to PrEP prescribing included a lack of PrEP training, a lack of clinical leadership regarding PrEP, patient lack of insurance, and likelihood of low patient adherence. This study contributes to the body of knowledge regarding PCP PrEP prescribing practices. Findings from this study may inform future interventions that aim to enhance PrEP prescribing among primary care providers who serve Southern African American individuals at risk for acquisition of HIV disease.

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Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US

Cited by 11 publications

References 23 publications

How Do Family Physicians Perceive Their Role in Providing Pre-exposure Prophylaxis for HIV Prevention?–An Online Qualitative Study in Flanders, Belgium

How Do Family Physicians Perceive Their Role in Providing Pre-exposure Prophylaxis for HIV Prevention?–An Online Qualitative Study in Flanders, Belgium

Implementing Pre-exposure Prophylactic Therapy in Primary Care

Primary care provider prep prescribing practices : southern United States

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