Brief Report: Informing Strategies to Build PrEP Capacity Among San Francisco Bay Area Clinicians

Bacon, Oliver; González, Rafael I.; Andrew, Erin; Potter, Michael B.; Iñiguez, James R.; Cohen, Stéphanie; Liu, Albert Y.; Fuchs, Jonathan

doi:10.1097/qai.0000000000001182

Cited by 34 publications

(13 citation statements)

References 18 publications

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“…Results from this study demonstrate that pharmacy students were highly aware of PrEP and reported relatively high familiarity with prescribing guidelines. The high level of awareness is consistent with previous studies of HIV specialists and primary care providers 12,16,17,28,29 yet higher than in other studies of pharmacists 23 and medical providers. 19,30 A key finding in the analysis pertains to the connection between reported familiarity with PrEP prescribing guidelines and knowledge.…”

Section: Discussionsupporting

confidence: 90%

Awareness, knowledge, and attitudes towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among pharmacy students

Przybyla

Parks

Sawyer

et al. 2019

Currents in Pharmacy Teaching and Learning

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Introduction: The purpose of this study was to assess pharmacy students’ awareness, knowledge, and perceptions towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), confidence and intentions to counsel patients on PrEP, and preferred PrEP training. Methods: A web-based cross-sectional survey was conducted with pharmacy students. Descriptive statistics and multivariate logistic regressions were performed. Results: Ninety-one percent of participants were aware of PrEP and 61% were familiar with PrEP prescription guidelines. In multivariate analysis, greater PrEP knowledge, attitudes towards PrEP, and familiarity with prescribing guidelines were significantly associated with confidence in PrEP counseling (p < 0.01 for all). Males had significantly higher odds of reporting confidence in PrEP counseling relative to their female counterparts (p < 0.01). Relative to fourth year students, second year students were less likely to report confidence in PrEP counseling (p < 0.01). Participants who were familiar with prescribing guidelines had significantly higher odds of PrEP counseling intentions (p < 0.05). Preferred educational topics regarding PrEP included training on side effects and adherence monitoring (65% and 51%, respectively). The most preferred modalities for receiving PrEP education were online education (47%), educational seminars in required courses (43%), and self-study modules (39%). Conclusions: Given the key role played by pharmacists in patient engagement, they may be presented with opportunities to provide PrEP counseling and education. The development of educational modules for pharmacy students in an effort to increase PrEP uptake should consider addressing gaps in knowledge and preferred training modalities.

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Section: Discussionsupporting

confidence: 90%

Awareness, knowledge, and attitudes towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among pharmacy students

Przybyla

Parks

Sawyer

et al. 2019

Currents in Pharmacy Teaching and Learning

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“…Suggestions from the contraceptive and oral PrEP studies on how to overcome these issues may be helpful. For instance, concerted efforts (eg, trainings) to ensure that providers have accurate information about PrEP [ 37 , 38 ] implants (including information on insertion and removal techniques) and effective tools to identify PrEP implant candidates could be helpful. Same-day access to PrEP implant insertion could also boost uptake [ 39 ]; offering PrEP implants in emergency department settings could also boost implant uptake.…”

Section: Discussionmentioning

confidence: 99%

Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study

et al. 2020

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Background A long-acting implant for HIV pre-exposure prophylaxis (PrEP) is in development in the Sustained Long-Action Prevention Against HIV (SLAP-HIV) trial. This could provide an alternative to oral PrEP. Objective Our mixed methods study aimed to understand (1) users’ experiences with a similar subdermal implant for contraception and (2) factors influencing the likelihood that gay and bisexual men (GBM) would use a proposed PrEP implant. Methods Work was completed in 4 stages. In stage 1, we conducted a scientific literature review on existing subdermal implants, focusing on users’ experiences with implant devices. In stage 2, we reviewed videos on YouTube, focusing on the experiences of current or former contraceptive implant users (as these implants are similar to those in development in SLAP-HIV). In stage 3, individuals who indicated use of a subdermal implant for contraception in the last 5 years were recruited via a web-based questionnaire. Eligible participants (n=12 individuals who liked implants a lot and n=12 individuals who disliked implants a lot) completed in-depth phone interviews (IDIs) about their experiences. In stage 4, results from IDIs were used to develop a web-based survey for HIV-negative GBM to rate their likelihood of using a PrEP implant on a scale (1=very unlikely and 5=very likely) based on likely device characteristics and implant concerns identified in the IDIs. Results In the scientific literature review (stage 1), concerns about contraceptive implants that could apply to the PrEP implants in development included potential side effects (eg, headache), anticipated high cost of the device, misconceptions about PrEP implants (eg, specific contraindications), and difficulty accessing PrEP implants. In the stage 2 YouTube review, individuals who had used contraceptive implants reported mild side effects related to their device. In stage 3, implant users reported that devices were comfortable, unintrusive, and presented only minor discomfort (eg, bruising) before or after insertion and removal. They mainly reported removing or disliking the device due to contraceptive-related side effects (eg, prolonged menstruation). Participants in the stage 4 quantitative survey (N=304) were mainly gay (204/238, 85.7%), white (125/238, 52.5%), cisgender men (231/238, 97.1%), and 42.0% (73/174) of them were on oral PrEP. Not having to take a daily pill increased the likelihood of using PrEP implants (mean 4.13). Requiring >1 device to achieve 1 year of protection (mean range 1.79-2.94) mildly discouraged PrEP implant use. Participants did not mind moderate bruising, a small scar, tenderness, or bleeding after insertion or removal, and an implant with a size slightly larger than a matchstick (mean ratings 3.18-3.69). Conclusions PrEP implants are promising among GBM. Implant features and insertion or removal-related concerns do not seem to discourage potential users. To ensure acceptability, PrEP implants should require the fewest possible implants for the greatest protection duration.

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“…Although PrEP is widely recognized as an efficacious HIV prevention tool, it is not commonly prescribed. Studies examining the adoption of PrEP offer limited insight on the role of APNs concerning PrEP (Bacon et al, 2017;Hakre et al, 2016;Mullins et al, 2015). This…”

Section: Pre-exposure Prophylaxis Risk Evaluation and Mitigationmentioning

confidence: 99%

“…Barriers to PrEP referral and prescription include a general lack of knowledge about PrEP, difficulty in identifying individuals most likely to benefit from a PrEP intervention and disagreement about the optimal healthcare settings to prescribe PrEP (Bacon et al, 2017;Karris, Beekmann, Mehta, Anderson, & Polgreen, 2014;Krakower, Ware, Mitty, Maloney, & Mayer, 2014). Some healthcare providers suggest an HIV specialist care setting is the optimal venue to prescribe PrEP because those practitioners understand the care of people living with HIV and are most comfortable with the required longitudinal patient motoring.…”

Section: Introductionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis uptake by advanced practice nurses: Interplay of agency, community and attitudinal factors

Jayawardene

Carter

Agley

et al. 2019

Journal of Advanced Nursing

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Aims To identify associations among agency, community, personal and attitudinal factors that affect advanced practice nurses’ uptake of HIV pre‐exposure prophylaxis, an intervention consists of emtricitabine/tenofovir once‐daily pill, along with sexual risk reduction education. Design Cross‐sectional. Methods During March‐May 2017, randomly selected Indiana advanced practice nurses were invited to complete an online survey, consisted of several validated self‐rating measures (N = 1,358; response = 32.3%). Final sample (N = 369) was predominantly White, non‐Hispanic, female advanced practice nurses in urban practices (mean age = 46). Conceptual model for structural equation model included 29 original/composite variables and five latent factors. Results Final model consisted of 11 variables and four factors: agency, community, HIV prevention practices (including screening) and motivation to adopt evidence‐based practices overall. Community had direct effects on HIV prevention practices (estimate = 0.28) and agency (estimate = 0.29). Agency had direct effects on HIV prevention practices (estimate = 0.74) and motivation to adopt evidence‐based practices (estimate = 0.24). Community had indirect effects, through agency, on the two remaining factors. Conclusion Barriers exist against pre‐exposure prophylaxis implementation, although practice guidelines are available. HIV prevention practices must be integrated across organizational structures, especially in high‐risk communities, whereas practice change is more effective when focused on changing providers’ attitudes towards intervention. When planning a pre‐exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership and community members, is crucial to success. Impact In settings where advanced practice nurses are primary contact points for health care, they may be best positioned to have an impact on implementation of HIV risk reduction strategies. Further research is needed to optimize their contributions to pre‐exposure prophylaxis implementation.

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Brief Report: Informing Strategies to Build PrEP Capacity Among San Francisco Bay Area Clinicians

Cited by 34 publications

References 18 publications

Awareness, knowledge, and attitudes towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among pharmacy students

Awareness, knowledge, and attitudes towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among pharmacy students

Understanding the Acceptability of Subdermal Implants as a Possible New HIV Prevention Method: Multi-Stage Mixed Methods Study

HIV pre‐exposure prophylaxis uptake by advanced practice nurses: Interplay of agency, community and attitudinal factors

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