Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

Storholm, Erik D.; Ober, Allison J.; Mizel, Matthew L.; Matthews, Luke J.; Sargent, Matthew; Todd, Ivy; Zajdman, Deborah; Green, Hank

doi:10.1521/aeap.2021.33.4.325

Cited by 27 publications

(18 citation statements)

References 42 publications

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“…Our findings are consistent with three recent studies addressing barriers to PrEP access, including a literature review from 2020 27 and others from 2021 based on interviews with primary care providers across the United States 28 and with women experiencing intimate partner violence and their providers in the Northeast. 29 Specifically, all the barriers to PrEP identified in the current study were identified in at least one of the other studies, with some, such as concerns about side effects and adherence and provider biases or stigma about who is at risk for HIV, being identified by all three studies.…”

Section: Discussionsupporting

confidence: 91%

“…31 Task shifting to non-prescribers in the care team was emphasized in a study of primary care providers' attitudes about PrEP that also identified the importance of integrating PrEP procedures into clinical workflows. 28 Our work therefore reinforces the importance of focusing PrEP implementation strategies on a full range of stakeholders, which aligns with bestpractices in implementation science methods that have been emphasized in the Federal Plan to End the HIV Epidemic. 32…”

Section: Discussionsupporting

confidence: 70%

“…29 Specifically, all the barriers to PrEP identified in the current study were identified in at least one of the other studies, with some, such as concerns about side effects and adherence and provider biases or stigma about who is at risk for HIV, being identified by all three studies. [27][28][29] Barriers identified in one or more of the other studies and not in the present study included disagreements over whether primary care providers or specialists should take the lead in PrEP prescribing, 27,28 which may be important to consider when training providers in Alabama in order to maximize provider motivation and engagement in PrEP regardless of their specialties.…”

Section: Discussionmentioning

confidence: 79%

See 2 more Smart Citations

Using Health Care Professionals’ Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama

Humphries

Rhodes

Simon

et al. 2022

J Int Assoc Provid AIDS Care

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Pre-exposure prophylaxis (PrEP) is underused in the southern United States (US), a region with high HIV incidence. Clinical decision support (CDS) tools could increase PrEP prescriptions. We explored barriers to PrEP delivery and views of CDS tools to identify refinements for implementation strategies for PrEP prescribing and PrEP CDS tools. We conducted focus groups with health care providers from two federally qualified health centers in Alabama and analyzed the results using rapid qualitative methods. Barriers to PrEP included providers’ lack of training in PrEP, competing priorities and time constraints during clinical visits, concerns about side effects, and intensive workload. We identified refinements to the planned implementation strategies to address the barriers, including training all clinic staff in PrEP and having CDS PrEP alerts in electronic health records sent to all staff. Development and deployment of CDS tools in collaboration with providers has potential to increase PrEP prescribing in high-priority jurisdictions.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 79%

See 1 more Smart Citation

Using Health Care Professionals’ Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama

Humphries

Rhodes

Simon

et al. 2022

J Int Assoc Provid AIDS Care

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“…TelePrEP may help clients who struggle to find time or transportation to travel to meet the monitoring requirements, especially those living in a PrEP desert [62][63][64]. The PrEP desert status is strongly associated with the Southern US and lower urbanicity where HIV stigma, poverty, and lack of insurance are prevalent [8,9]. TelePrEP in South Carolina, which showed the applicability of telePrEP services in a Southern urban area, is now expanding in Southern rural areas [54].…”

Section: Discussionmentioning

confidence: 99%

Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

Kamitani

Mizuno

DeLuca

et al. 2023

Aids

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Objectives: To identify types, evidence, and study gaps of alternative HIV preexposure prophylaxis (PrEP) care delivery models in the published literature. Design: Systematic review and narrative synthesis. Methods: We searched in the US Centers for Disease Control and Prevention (CDC) Prevention Research Synthesis (PRS) database through December 2022 (PROSPERO CRD42022311747). We included studies published in English that reported implementation of alternative PrEP care delivery models. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using the adapted Newcastle-Ottawa Quality Assessment Scale. Those that met our study criteria were evaluated for efficacy against CDC Evidence-Based Intervention (EBI) or Evidence-Informed Intervention (EI) criteria or Health Resources and Services Administration Emergency Strategy (ES) criteria, or for applicability by using an assessment based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: This review identified 16 studies published between 2018 and 2022 that implemented alternative prescriber (n = 8), alternative setting for care (n = 4), alternative setting for laboratory screening (n = 1), or a combination of the above (n = 3) . The majority of studies were US-based (n = 12) with low risk of bias (n = 11). None of the identified studies met EBI, EI, or ES criteria. Promising applicability was found for pharmacists prescribers, telePrEP, and mail-in testing. Conclusions: Delivery of PrEP services outside of the traditional care system by expanding providers of PrEP care (e.g. pharmacist prescribers), as well as the settings of PrEP care (i.e. telePrEP) and laboratory screening (i.e. mail-in testing) may increase PrEP access and care delivery.

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“…PCPs having limited experience and knowledge of PrEP is consistent with previous studies and has been shown to serve as a significant barrier to prescribing PrEP to their patients. [36][37][38] Because the likelihood of future PrEP understudied, but has the potential to improve user experience, although staff and cost-effectiveness has not been established. 45 This could be a direction for future implementation to reduce some of the patient-identified logistical and financial barriers related to multiple clinic appointments.…”

Section: Thematic Findingsmentioning

confidence: 99%

Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care

Nacht

Muthuramalingam

Storholm

et al. 2022

JCRHAP

Self Cite

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Although pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, only around 25% of at-risk individuals in the United States have accessed a prescription. One way to increase PrEP uptake is through the sexual health screening of patients and linkage to PrEP in primary care settings. The objective of this analysis was to assess the barriers and implementation strategies during a screening and linkage to PrEP pilot intervention. Primary care patients were screened for PrEP indication during routine primary care visits. Of the 1,225 individuals screened, 1.8% (n=22) were eligible for PrEP and from those, 77.3% (n=17) attended the specialist appointment and were prescribed PrEP. Primary care patients (n=30) and providers (n=8) then participated in semi-structured interviews assessing their experience with the pilot intervention. Using an applied thematic analytic approach, patients and providers identified barriers and related improvement strategies that could be classified into four main categories: 1) Financial Barriers: Individual- vs. Clinic-level Considerations 2) The Role of Stigma, Discomfort, and Cultural Factors 3) Logistical Hurdles and Streamlining the Intervention, and 4) The Lack of PrEP Knowledge and the Need for Education. Findings support the accepatability and feasibility of screening for PrEP in primary care along with appropriate implementation strategies. This study suggests that because of the high volume of patients seen in primary care, sexual health screenings and linkage to PrEP interventions have the potential to reduce new incident HIV infections among diverse sexual minority men.

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Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

Cited by 27 publications

References 42 publications

Using Health Care Professionals’ Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama

Using Health Care Professionals’ Perspectives to Refine a Clinical Decision Support Implementation Strategy for Increasing the Prescribing of HIV Preexposure Prophylaxis (PrEP) in Alabama

Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care

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