HIV Pre-Exposure Prophylaxis Implementation Cascade Among Health Care Professionals in the United States: Implications from a Systematic Review and Meta-Analysis

Zhang, Chen; McMahon, James M.; Fiscella, Kevin; Przybyla, Sarahmona M.; Braksmajer, Amy; Leblanc, Natalie M.; Liu, Yu

doi:10.1089/apc.2019.0119

Cited by 84 publications

(76 citation statements)

References 102 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that the odds of prescribing PrEP to patients with indications among NPs were higher than that among physicians. In contrast, the odds of being aware of PrEP among NPs are lower than their physician counterparts, which is consistent with the findings of a previous review study [17]. The top three most frequently reported barriers to PrEP care were consistent with findings from a recent synthesized analysis [17], including lack of request from patients, concerns about toxicity and resistance, and lack of knowledge about PrEP.…”

Section: Discussionsupporting

confidence: 88%

“…The lack of requests from patients ranked as the top reported barrier to PrEP care, and facilitating PrEP discussions may be a leeway for this barrier. Although studies have demonstrated that positive patient-provider relationships can foster patient engagement across HIV care and reduce health disparities across among individuals with [17,42]. In addition, providers' concerns regarding the toxicity and resistance of PrEP as well as the lack of PrEP knowledge revealed that insufficient support or training programs were available for healthcare providers regarding PrEP care.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, Nunn and colleagues proposed a PrEP care cascade model, which suggests that progression along stages of the cascade must involve interaction and engagement for both PrEP users and health providers (FigS1) [16]. A recent study described the role of health providers in terms of the PrEP care cascade and found 68% of them aware of PrEP, 66% willing to prescribe, and 24% ever prescribing [17]. However, the previous study did not distinguish from non-physicians from physicians, who may play different but essential roles in PrEP care.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Understanding the role of nurse practitioners, physician assistants and other nursing staff in HIV pre-exposure prophylaxis care in the United States: a systematic review and meta-analysis

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Although pre-exposure prophylaxis (PrEP) was approved for primary HIV prevention by the Federal Drug Administration in 2012, PrEP utilization has been suboptimal. A body of literature and programs has emerged to examine the role of nurse practitioners (NPs), physician assistants and nursing staff in PrEP care. This review aims to understand the current status of non-physician health providers in PrEP care implementation in the United States. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, we conducted a comprehensive literature search using multiple databases to identify peer-reviewed articles that examined the role of non-physician health providers in the implementation of PrEP. Four major databases of studies using observational study design, randomized control trials and mixed-method study design were screened from November 2019 to January 2020 were searched. Two independent reviewers examined eligibility and conducted data extraction. We employed random-effects model aims to capture variances of estimates across studies. Results A total of 26 studies with 15,789 health professionals, including NPs (18, 95% CI = 14,24%), physician assistants (6, 95% CI = 2, 10%), nursing staff (26, 95% CI = 18–34%), and physicians (62,95% CI = 45, 75%), were included in the analysis. The odds of prescribing PrEP to patients among NPs were 40% (OR = 1.40, 95% CI = 1.02,1.92) higher than that among physicians, while the likelihood of being willing to prescribe PrEP was similar. On the other hand, the odds of being aware of PrEP (OR = 0.63, 95% CI = 0.46, 0.87) was 37% less in nursing professionals than that among physicians. Conclusions Although the limited number and scope of existing studies constrained the generalizability of our findings, the pattern of PrEP care implementation among non-physician health providers was described. To achieve wider PrEP care implementation in the U.S., increasing awareness of PrEP among all health providers including both physicians and non-physicians is a key step.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Understanding the role of nurse practitioners, physician assistants and other nursing staff in HIV pre-exposure prophylaxis care in the United States: a systematic review and meta-analysis

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…In our study, electronic dissemination of a brief educational video showed promise for supporting women’s awareness and consideration of PrEP and the potential to indirectly promote PrEP awareness within the larger community. Many providers throughout the US have not yet adopted PrEP into practice [ 29 ], and many who have discussed PrEP with patients have done so on a selective basis. Such a non-standardized approach may contribute to suboptimal PrEP use and access disparities [ 30 ], especially among populations with low PrEP awareness and limited outside opportunities to learn about PrEP.…”

Section: Discussionmentioning

confidence: 99%

Electronic Dissemination of a Web-Based Video Promotes PrEP Contemplation and Conversation Among US Women Engaged in Care at Planned Parenthood

et al. 2021

View full text Add to dashboard Cite

We evaluated the acceptability and impact of a web-based PrEP educational video among women ( n = 126) by comparing two Planned Parenthood centers: one assigned to a Web Video Condition and one to a Standard Condition. Most women reported the video helped them better understand what PrEP is (92%), how PrEP works (93%), and how to take PrEP (92%). One month post-intervention, more women in the Web Video Condition reported a high level of comfort discussing PrEP with a provider (82% vs. 48%) and commonly thinking about PrEP (36% vs. 4%). No women with linked medical records initiated PrEP during 1-year follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03210-2.

show abstract

“…Despite the demonstration of PrEP acceptability among GBT youth [23], PrEP utilization estimated from 2017 national data was only 9.4% among young men who have sex with men (MSM) compared with 19.9% among all MSM [24]. Although the proportion of health care providers prescribing PrEP in the United States has risen to 24%, differences in PrEP use between racial/ethnic groups remain, with a use percentage of 26% among eligible Black MSM versus 42% among White MSM [25]. Moreover, once initiated, PrEP adherence has been found to be suboptimal among young MSM, even when paired with tailored behavioral interventions [23,26].…”

Section: Hiv Prevention and Treatment Continuamentioning

confidence: 99%

Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint

et al. 2021

View full text Add to dashboard Cite

Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN's research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth.

show abstract

HIV Pre-Exposure Prophylaxis Implementation Cascade Among Health Care Professionals in the United States: Implications from a Systematic Review and Meta-Analysis

Cited by 84 publications

References 102 publications

Understanding the role of nurse practitioners, physician assistants and other nursing staff in HIV pre-exposure prophylaxis care in the United States: a systematic review and meta-analysis

Understanding the role of nurse practitioners, physician assistants and other nursing staff in HIV pre-exposure prophylaxis care in the United States: a systematic review and meta-analysis

Electronic Dissemination of a Web-Based Video Promotes PrEP Contemplation and Conversation Among US Women Engaged in Care at Planned Parenthood

Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint

Contact Info

Product

Resources

About