Primary Care Physicians’ Willingness to Prescribe HIV Pre-exposure Prophylaxis for People who Inject Drugs

Edelman, E. Jennifer; Moore, Brent A.; Calabrese, Sarah K.; Berkenblit, Gail; Cunningham, Chinazo O.; Patel, Viraj V.; Phillips, Karran A.; Tetrault, Jeanette M.; Shah, Minesh; Fiellin, David A.; Blackstock, Oni J.

doi:10.1007/s10461-016-1612-6

Cited by 85 publications

(58 citation statements)

References 31 publications

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“…Several papers focused on transgender women [ 49 , 53 , 62 ], Black and Latina women [ 48 ], Black and Latino MSM [ 51 ], adolescents [ 65 , 66 ], men who engage in street-based sex work [ 46 ], heterosexual couples [ 69 ], and people who inject drugs [ 43 , 63 ]. These papers point to stigma associated with PrEP use and the intersection of HIV-stigma with transphobia and homophobia [ 48 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

et al. 2018

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There are many challenges to accessing PrEP and thus low uptake in the United States. This review (2007–2017) of PrEP implementation identified barriers to PrEP and interventions to match those barriers. The final set of articles (n = 47) included content on cognitive aspects of HIV service providers and individuals at risk for infection, reviews, and case studies. Cognitive barriers and interventions regarding patients and providers included knowledge, attitudes, and beliefs about PrEP. The “purview paradox” was identified as a key barrier—HIV specialists often do not see HIV-negative patients, while primary care physicians, who often see uninfected patients, are not trained to provide PrEP. Healthcare systems barriers included lack of communication about, funding for, and access to PrEP. The intersection between PrEP-stigma, HIV-stigma, transphobia, homophobia, and disparities across gender, racial, and ethnic groups were identified; but few interventions addressed these barriers. We recommend multilevel interventions targeting barriers at multiple socioecological domains.

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Section: Resultsmentioning

confidence: 99%

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

et al. 2018

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“…Another theme we identified in the literature was the belief that being on PrEP would cause individuals to engage in more ''risky'' behavior, such as having sex without a condom or not inquiring about STIs before engaging in sexual activity. 25,[27][28][29]33,34,36,37,39,42,43,45,49,50 Although in most studies worries about risk compensation were minimal, it did emerge as a common theme across the reviewed literature. Specifically, 26% of Washington State providers believed that being on PrEP could increase engagement in risky sexual behavior.…”

Section: Concerns About Behavioral and Health Consequencesmentioning

confidence: 99%

“…36,37 Some providers even stated that higher-risk individuals would be better off using condoms instead of PrEP. 33 Another study found that fears of risk compensation were more prominent in providers with little PrEP prescribing experience. 27 In addition to concerns about risk compensation, providers in another reviewed study worried about HIV resistance caused by PrEP, cited minimal concerns about side effects, but recognized the importance of monitoring patients to minimize risks.…”

Section: Concerns About Behavioral and Health Consequencesmentioning

confidence: 99%

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

Pleuhs

Quinn

Walsh

et al. 2020

AIDS Patient Care and STDs

168

128

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Increasing prescription of pre-exposure prophylaxis (PrEP) is imperative to ending the HIV epidemic in the United States. The objective of this review was to identify health care provider barriers to PrEP implementation. A systematic review was conducted in February 2019 using PubMed to identify barriers to PrEP prescribing practices in the United States. Targeted search terms surrounding PrEP and providers resulted in 222 original studies, 28 of which were ultimately included in our review, with data collected between 2011 and 2018. Six themes were identified across reviewed studies: (i) a lack of PrEP knowledge, (ii) the presence of the Purview Paradox, which refers to discordance in beliefs between HIV specialists and primary care providers on who should prescribe PrEP, (iii) concerns about PrEP costs, (iv) concerns about behavioral and health consequences, (v) interpersonal stigma, and (vi) concerns about patient adherence. A majority of providers were lacking knowledge regarding PrEP, resulting in discomfort in prescribing PrEP, or limited awareness and understanding of PrEP clinical guidelines. Discrepant opinions were identified regarding whether PrEP was best managed within primary care or specialty clinics. Other barriers included concerns about cost, patient adherence, and follow-up maintenance care. Finally, concerns about risk compensation and discomfort discussing sexual activities with patients who would benefit most from PrEP were apparent. Additional work is needed to prepare providers to prescribe and manage patients on PrEP, optimize PrEP delivery, and reduce provider bias. Future research is needed to identify providers' attitudes and beliefs regarding innovations in PrEP dosing, task shifting, and novel strategies for PrEP care.

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“…PrEP uptake may also be insufficient in people who inject drugs (PWID). A survey of primary care physicians showed over one-quarter had low willingness to prescribe PrEP to PWID, despite some PWIDs having a substantial risk for HIV acquisition [9]. Cisgender women at risk of HIV also have relatively low PrEP uptake.…”

Section: Introductionmentioning

confidence: 99%

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

2020

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Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.

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Primary Care Physicians’ Willingness to Prescribe HIV Pre-exposure Prophylaxis for People who Inject Drugs

Cited by 85 publications

References 31 publications

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

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