Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

Abstract

Introduction/Objectives: Pre-exposure prophylaxis (PrEP) use in the southern United States is low despite its effectiveness in preventing HIV acquisition and high regional HIV prevalence. Our objectives were to assess PrEP knowledge, attitudes, and prescribing practices among Tennessee primary care providers. Methods: We developed an anonymous cross-sectional electronic survey from March to November 2019. Survey development was guided by the Capability, Opportunity, Motivation, and Behavior framework and refined through piloting and interviews. Participants included members of professional society and health center listservs licensed to practice in Tennessee. Respondents were excluded if they did not complete the question regarding PrEP prescription in the previous year or were not in a position to prescribe PrEP (e.g., hospital medicine). Metrics included PrEP prescription in the preceding year, PrEP knowledge scores (range 0-8), provider attitudes about PrEP, and provider and practice characteristics. Knowledge scores and categorical variables were compared across PrEP prescriber status with Wilcoxon rank-sum and Fisher’s exact tests, respectively. Results: Of 147 survey responses, 99 were included and 43 (43%) reported PrEP prescription in the preceding year. Compared with non-prescribers: prescribers had higher median PrEP knowledge scores (7.3 vs 5.6, P < .01), a higher proportion had self-reported patient PrEP inquiries (95% vs 21%, P < .01), and a higher proportion had self-reported good or excellent ability to take a sexual history (83% vs 58%, P = .01) and comfort taking a sexual history (92% vs 63%, P < .01) from men who have sex with men, a subgroup with high HIV risk. Most respondents felt obligated to provide PrEP (65%), and felt all primary care providers should provide PrEP (63%). Conclusion: PrEP provision is significantly associated with PrEP knowledge, patient PrEP inquiries, and provider sexual history taking ability and comfort. Future research should evaluate temporal relationships between these associations and PrEP prescription as potential routes to increase PrEP provision.

Factors Influencing the Intention of MSM to Use the PrEP Intelligent Reminder System

“…of IRS is an important step in recommending its use. It is equally important to enhance the capacity of healthcare providers 39,40. …”

Effectiveness of an electronic health record model for HIV pre-exposure prophylaxis

“…A previous study found that patient request for PrEP was significantly associated with prescriptions; therefore, efforts should also focus on patient education about PrEP. 11 Additionally, providers felt more comfortable discussing sexual history with patient populations such as MSM but felt the least comfortable with transgender populations. 11 Educating providers on how to navigate conversations about sexual practices and PrEP with all patients may be an important step for increasing PrEP use.…”

“…11 Additionally, providers felt more comfortable discussing sexual history with patient populations such as MSM but felt the least comfortable with transgender populations. 11 Educating providers on how to navigate conversations about sexual practices and PrEP with all patients may be an important step for increasing PrEP use. For this BPA to accurately flag a patient as meeting criteria for PrEP use, sexual orientation and gender identity needed to be documented in the chart.…”

Assessment of Oncology Advanced Practice Professional Willingness to Participate in Medical Aid in Dying

“…11,13 For instance, in a sample of Minnesota physicians, 58.1% felt that cannabis was a legitimate medical treatment but 50.0% did not feel ready or did not want to answer patient questions about cannabis. 10 Moore et al 11 found that a majority of clinicians felt they were obligated to provide information and to prescribe HIV PrEP, as well as to refer a patient if they could not prescribe, despite low rates of prescribing. Authors have found that clinicians who have prescribed PrEP are more comfortable taking a sexual history, more knowledgeable about PrEP, and more likely to have had a patient request it.…”

“…[6][7][8] Prior studies also looked at these factors in relation to advance care planning and hospice referrals 9 as well as other potentially controversial topics such as cannabis use 10 and HIV preexposure prophylaxis (PrEP). [11][12][13][14] Finally, it is important to understand to what extent existing concerns about physician participation in MAID-such as inaccuracy of prognostication, conflict with professional norms and roles, and potential worsening of preexisting social and cultural biases against older adults and individuals with terminal illness-apply to APP participation. 15,16 Although the American Medical Association now includes ethical arguments both for and against MAID, its formal stance remains one of opposition to physician participation.…”