Unlocking HIV Pre-Exposure Prophylaxis Delivery: Examining the Role of HIV Providers in Pre-Exposure Prophylaxis Care

Abstract

Despite being a promising prevention strategy for populations at risk for HIV acquisition, there has not been rapid uptake of HIV antiretroviral pre-exposure prophylaxis (PrEP). Yet, HIV clinics within the Mount Sinai Health System in New York City have successfully incorporated PrEP. HIV care providers (n = 18), who practice in these clinics and were early PrEP adopters, participated in a survey and semistructured interview. Qualitative thematic analysis revealed that barriers and facilitators to PrEP uptake were identified on multiple levels from broader systemic to provider-and-patient-level concerns. The following themes were identified: (1) to reach a greater proportion of patients at risk for HIV and address racial/ethnic and gender disparities, PrEP should be available in a variety of settings and provided by different types of providers within proximity to affected populations; (2) financial support is needed beyond addressing medication cost; and (3) multidisciplinary teams and populationspecific clinic protocols can assist providers in conducting high-quality visits and addressing these barriers to PrEP.

Knowledge, attitudes and practices of oral HIV pre-exposure prophylaxis (PrEP) among healthcare workers in the Ekurhuleni District, South Africa

“…Our study revealed that almost a third of participants did not include HIV PrEP service in general service points. This is similar to studies that were conducted by Kenison et al [30] and Muwonge et al, [26] which revealed that poor practices of PrEP delivery are demonstrated by referring patients requiring HIV PrEP prescriptions to other health providers who are stationed at different service…”

Incidence and Determinants of loss to follow-up of HIV pre-exposure prophylaxis among key and priority population groups in Addis Ababa health centers, Ethiopia retrospective cohort study

“…In the final model, after adjusting for other covariates being male is associated with a 1.77 times higher risk of getting lost as compared to being female (ARR=1.770, 95% CI =1.120, 2.797). In addition, the risk of getting lost from PrEP follow-up youngest (21–30) years was 0.406 times lower than those aged (51–60) years (ARR=0.406, 95% CI =0.223, 0.738, P-value=0.003). similarly, those in the age of (31–40) years was associated with a 1.77 times risk of loss compared with (51–60) years (ARR= 0.391, 0.641 Vs. 1.77 95% CI).…”

“…High adherences is especially important among male, as compared to women using PrEP, to achieve high efficacy of PrEP because of differences in perception and health seeking behavior (20). Approach based on their gender during initiation of PrEP and during their follow up time based on their needs, Providers' suggestion and support of PrEP use have also been suggested as effective solutions to improve retention in PrEP care in a variety of diverse situations (21,22). This study shows that PrEP patients are at high risk of loss to follow-up at the early stage of PrEP initiation was 1.815 times LTFU the incidence who didn't have frist follow up visit).…”

“…In the final model, after adjusting for other covariates being male is associated with a 1.77 times higher risk of getting lost as compared to being female (ARR=1.770, 95% CI =1.120, 2.797). In addition, the risk of getting lost from PrEP follow-up youngest (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) Those who had a first follow-up visit according to their follow-up time were associated with 18.1% lower chances for lost than as compared to those who didn't have a first follow-up visit (ARR=1.81, 95% CI=1.211-2.72). In the addition, those who had a didn't have third follow-up visit according to their follow-up time were associated with 1.08 times for lost than as compared to those who have a third follow-up visit (ARR=1.08, 95% CI=1.27, 2.59).…”