Optimizing Provider Preexposure Prophylaxis (PrEP) Training: A Cross-Sectional Analysis of Recommendations from Providers Across the PrEP Implementation Cascade

Abstract

Expanding PrEP access necessitates training that supports healthcare providers’ progression along the PrEP implementation cascade, moving from PrEP awareness to prescription. We surveyed 359 USA providers about PrEP training content and format recommendations. We examined the association between cascade location and training recommendations. Most providers were aware of PrEP (100%), willing to prescribe PrEP (97.2%), had discussed PrEP with patients (92.2%), and had prescribed PrEP (79.9%). Latent class regression analysis revealed that cascade location was associated with training recommendations. Although all providers recommended PrEP-specific content (e.g., patient eligibility), providers who were located further along the cascade also recommended more comprehensive content, including sexual history-taking and sexual and gender minority competence training. Providers further along the cascade were also more likely to recommend interactive training formats (e.g., role-playing). These insights from providers furthest along the cascade indicate the importance of including comprehensive content and interactive formats in future PrEP training initiatives. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-021-03375-w.

Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training

“…Although, as expected, prescribing providers had higher self-efficacy scores compared to nonprescribing providers, both groups were least confident in PrEP initiation compared to the other steps of PrEP care. This finding aligns with previous literature describing low PrEP prescription rates despite a high-level of provider awareness and support for PrEP in the United States [ 8 , 33 , 34 ]. Furthermore, other studies have suggested that decreased knowledge about insurance navigation (a component of the PrEP initiation step) stymies providers’ ability to prescribe PrEP [ 33 , 35 ].…”

“…Our findings inform how provider training can be optimized and tailored to improve provider knowledge, attitudes, and self-efficacy in PrEP care [ 8 , 33 ]. Customized provider training has been associated with effective implementation of other healthcare interventions, such as improving negative attitudes towards buprenorphine prescription for opioid use disorder [ 32 ] and facilitating effective implementation of evidence-based tobacco use treatment in health centers [ 37 ].…”

“…Furthermore, other studies have suggested that decreased knowledge about insurance navigation (a component of the PrEP initiation step) stymies providers’ ability to prescribe PrEP [ 33 , 35 ]. Lack of onsite primary care services and lack of Medicaid expansion may exacerbate insurance navigation challenges and contribute to lower provider confidence in PrEP initiation [ 33 , 35 , 36 ].…”

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

“…In our research, we experienced the value of combining advice and instant feedback of routinized experts with peer discussions. A recent study from the U.S. also found that PrEP-experienced providers recommended interactive formats for future training initiatives on PrEP ( 48 ).…”

Scaling up preexposure prophylaxis to maximize HIV prevention impact

“…Using telemedicine linked with home or community-based HIV and STI testing may reduce the burden of clinic visits [31], particularly for patients living in nonurban settings. Clinician training is critical and has been shown to increase rates of PrEP prescribing [37].…”