HIV Providers’ Perceived Barriers and Facilitators to Implementing Pre-exposure Prophylaxis in Care Settings: A Qualitative Study

Krakower, Douglas S.; Ware, Norma C.; Mitty, Jennifer A.; Maloney, Kevin M.; Mayer, Kenneth H.

doi:10.1007/s10461-014-0839-3

Cited by 274 publications

(273 citation statements)

References 25 publications

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“…Class two had a slightly higher probability of agreeing that cost might pose a substantial barrier (Castel et al, 2015). Both groups of providers also identified the risk for drug resistance and risk compensation as potential barriers to PrEP use-findings that were consistent with the results of other studies of potential physician providers of PrEP (Blumenthal et al, 2015;Caceres et al, 2015;Castel et al, 2016;Hakre et al, 2016;Hankins et al, 2015;Karris et al, 2014;Krakower et al, 2014;Krakower et al, 2015;Krakower and Mayer, 2016;Puro et al, 2013;Smith et al, 2016).…”

Section: Costsupporting

confidence: 77%

“…In a study of 39 HIV care providers, participants discussed the issue of patient adherence to medication regimens as a barrier to PrEP efficacy (Krakower et al, 2014). Whether provider concerns over PrEP efficacy in all the studies reviewed were related to adherence, rather than efficacy of the drug regimen, is unclear; however, patient adherence was frequently cited as a reservation.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Prescribers were hesitant in prescribing PrEP because the effectiveness of the drug was considered equivocal (Blumenthal et al, 2015;Caceres et al, 2015;Castel et al, 2016;Hakre et al, 2016;Hankins et al, 2015;Karris et al, 2014;Krakower et al, 2014;Krakower et al, 2015;Krakower and Mayer, 2016;Puro et al, 2013;Smith et al, 2016). PCPs reported lack of knowledge or training about PrEP as the main barrier in prescribing PrEP and in providing PrEP education to patients (Hakre et al, 2016).…”

Section: Safety/effectivenessmentioning

confidence: 99%

“…Most (>80%) providers agreed that new studies showing efficacy, patient request, ease of patient obtaining PrEP, and recommendations from CDC would likely increase their use of PrEP (Blumenthal et al, 2015). Many of the reports indicated that patients would become resistant to the drug and that it would essentially be ineffective, which limited their willingness to prescribe PrEP (Blumenthal et al, 2015;Caceres et al, 2015;Castel et al, 2016;Hakre et al, 2016;Hankins et al, 2015;Karris et al, 2014;Krakower et al, 2014;Krakower et al, 2015;Krakower and Mayer, 2016;Puro et al, 2013;Smith et al, 2016).…”

Section: Safety/effectivenessmentioning

confidence: 99%

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Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

Grippo

Smallwood

Pincura

et al. 2017

JGPHA

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Background:In the United States, human immunodeficiency virus (HIV) remains a substantial public health issue. There is evidence that the use of antiretroviral medications such as pre-exposure prophylaxis (PrEP) can be a safe and effective primary prevention strategy to reduce new cases of HIV infection. Provider practice behavior as it relates to prescribing PrEP and the potential impact on specific vulnerable populations needs increased attention. Few studies have evaluated the attitudes of physicians towards ethical issues related to prescribing PrEP. Methods:The purpose of the present literature review was to evaluate provider attitudes toward the ethics of prescribing PrEP for individuals at risk of acquiring HIV infection. Searches of the PubMed and Cochrane databases were conducted. Three reviewers independently assessed the relevance of articles and discarded those not directly related to the attitudes of physicians toward ethics of the cost, safety, and resource allocation of PrEP. A total of twenty-one articles were included in the review.Results: Provider attitudes and perceptions focused on three areas: resource allocation, cost, and safety or effectiveness of PrEP. Providers who were hesitant in prescribing PrEP were concerned with the availability of resources, patient adherence, risk of drug resistance, and toxicity. In the studies reviewed, few providers had prescribed PrEP; however, prescribing practices trended upward with time and awareness. Conclusions:Realization of the benefits of PrEP will require a utilitarian ethical approach to identifying the populations that will benefit most, monitoring for adverse effects, addressing costs, and educating and training providers to prescribe PrEP responsibly. Ensuring that PrEP fulfills its potential as part of a combination regimen for HIV prevention requires identification of additional evidence, education, support services, and resources that are needed, as well as the regulatory framework and cost scenarios for access to PrEP.

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Section: Costsupporting

confidence: 77%

Section: Discussion/conclusionmentioning

confidence: 99%

Section: Safety/effectivenessmentioning

confidence: 99%

Section: Safety/effectivenessmentioning

confidence: 99%

See 2 more Smart Citations

Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

Grippo

Smallwood

Pincura

et al. 2017

JGPHA

View full text Add to dashboard Cite

show abstract

“…Additionally, PCPs primarily deliver care to HIV-negative individuals, some of whom may be at substantial HIV risk, and therefore PrEPeligible. 17,19 Despite the potentially important role of PCPs in implementing PrEP (i.e., incorporating PrEP into clinical practice), earlier studies of providers' PrEP-related attitudes and potential role in PrEP adoption (i.e., commitment to and initial use of PrEP, defined in this study as a prescription of or referral for PrEP) 20 have focused mainly on HIV specialists, 12,15,[21][22][23][24] such as infectious disease (ID) physicians, and/or have been limited to specific geographic regions of the U.S. 13,16,[25][26][27][28][29] No published studies of PrEP adoption have focused exclusively on general internists, which is notable, given that they are abundant, geographically distributed throughout the U.S., and uniquely positioned to offer PrEP to persons at high risk of HIV infection.…”

Section: Introductionmentioning

confidence: 99%

A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians

et al. 2016

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BACKGROUND: Among health care providers, prescription of HIV pre-exposure prophylaxis (PrEP) has been low. Little is known specifically about primary care physicians (PCPs) with regard to PrEP awareness and adoption (i.e., prescription or referral), and factors associated with adoption. OBJECTIVE: To assess PrEP awareness, PrEP adoption, and factors associated with adoption among PCPs. DESIGN: Cross-sectional online survey conducted in April and May 2015. RESPONDENTS: Members of a national professional organization for academic primary care physicians (n = 266). MAIN MEASURES: PrEP awareness, PrEP adoption (ever prescribed or referred a patient for PrEP [yes/no]), provider and practice characteristics, and self-rated knowledge, attitudes, and beliefs associated with adoption. KEY RESULTS: The survey response rate was 8.6 % (266/2093). Ninety-three percent of respondents reported prior awareness of PrEP. Of these, 34.9 % reported PrEP adoption. In multivariable analysis of provider and practice characteristics, compared with non-adopters, adopters were more likely to provide care to more than 50 HIV-positive patients (vs. 0, aOR = 6.82, 95 % CI 2.06-22.52). Compared with non-adopters, adopters were also more likely to report excellent, very good, or good selfrated PrEP knowledge (15.1 %, 33.7 %, 30.2 % vs. 2.5 %, 18.1 %, 23.8 %, respectively; p < 0.001) and to perceive PrEP as extremely safe (35.1 % vs. 10.7 %; p = 0.002). Compared with non-adopters, adopters were less likely to perceive PrEP as being moderately likely to increase risk behaviors ("risk compensation") (12.8 % vs. 28.8 %, p = 0.02). CONCLUSIONS: While most respondents were aware of PrEP, only one-third of PrEP-aware PCPs reported adoption. Adopters were more likely to have experience providing HIV care and to perceive PrEP as extremely safe, and were less likely to perceive PrEP use as leading to risk compensation. To enhance PCP adoption of PrEP, educational efforts targeting PCPs without HIV care experience should be considered, as well as training those with HIV care experience to be PrEP "clinical champions". Concerns about safety and risk compensation must also be addressed.

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HIV Preexposure Prophylaxis—The Role of Primary Care Clinicians in Ending the HIV Epidemic

Khalili

Landovitz

2020

JAMA Intern Med

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HIV Providers’ Perceived Barriers and Facilitators to Implementing Pre-exposure Prophylaxis in Care Settings: A Qualitative Study

Cited by 274 publications

References 25 publications

Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

Physician Attitudes Toward the Ethics of Pre-exposure Prophylaxis (PrEP): Cost, Safety, and Resource Allocation

A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians

HIV Preexposure Prophylaxis—The Role of Primary Care Clinicians in Ending the HIV Epidemic

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