Health Care Provider Perspectives on Pre-exposure Prophylaxis: A Qualitative Study

Przybyla, Sarahmona M.; LaValley, Susan; Vil, Noelle M. St.

doi:10.1097/jnc.0000000000000073

Cited by 16 publications

(24 citation statements)

References 31 publications

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“…These findings confirm and extend the international literature on the 'purview paradox' 3,[21][22][23][24][25] in HIV care, with both explicit and implicit views communicated about which professionals are best qualified to delivery PrEP effectively. For example, despite relying on GPs to accept those PrEP referrals that sexual health clinics could no longer manage, sexual health clinicians were (often unfairly) sceptical of GP provision of PrEP, reproducing the long documented tendency to view HIV as an 'epidemic of complexities', 47 and a health condition best managed by those with extensive background in the area.…”

Section: Discussionsupporting

confidence: 83%

“…31 However, the requirement that only doctors (and nurse practitioners) can prescribe in Australia means that sexual health nurses have ended up playing a more restricted role in PrEP provision than in demonstration studies. Although literature on the purview paradox has focussed on the division between primary care and specialist care, 3,[21][22][23][24][25] which we also found, our participants also described a tension between who is allowed to prescribe PrEP (doctors and nurse practitioners) and who is not (most sexual health nurses). Prescribing rights are important to consider as a different dimension of the purview paradox.…”

Section: Discussionmentioning

confidence: 67%

“…21 Similar to the USA, there has been a 'purview paradox' debate in Australia, discussing whether PrEP is best provided by specialist or primary care physicians. [22][23][24][25] One study has focussed on Australian GPs and PrEP, and it found that GPs in North Queensland in 2017 reported willingness but low confidence in prescribing PrEP. 16 Previous Australian research has revealed that it is difficult for GPs to develop HIV expertise due to lack of patient demand, 26,27 and this may apply to PrEP prescribing.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians

et al. 2021

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Background: HIV pre-exposure prophylaxis (PrEP) has been rapidly implemented in Australia, initially through restricted access in demonstration studies, and then through prescribing across sexual health clinics and general practice settings. In 2018, PrEP was publicly subsidised for people with Medicare (universal health insurance for citizens, permanent residents and those from countries with reciprocal arrangements). There is little research examining the experiences of PrEP providers in Australia, and existing research has been primarily conducted before public subsidy. Methods: In this qualitative study, we examine the challenges that have emerged for PrEP-providing clinicians after public subsidy for PrEP was introduced. We conducted 28 semi-structured interviews in 2019-20 with PrEP providers in two Australian states, and analysed data thematically. Participants included general practitioners (GPs), sexual health nurses and sexual health physicians. Results: Sexual health services have been reconfigured to meet changing patient demand, with an emphasis on ensuring equitable financial access to PrEP. Restrictions to nurse-led PrEP frustrated some participants, given that nurses had demonstrated competence during trials. GPs were believed to be less effective at prescribing PrEP, but GP participants themselves indicated that PrEP was an easy intervention, but difficult to integrate into general practice. Participants expressed discomfort with on-demand PrEP. Conclusions: Our findings indicate that supporting ways for patients without Medicare to access PrEP inexpensively, advocating for nurse-led PrEP, and developing guidelines adapted to general practice consultations could ensure that PrEP is delivered more effectively and equitably. Additionally, PrEP providers require encouragement to build confidence in providing on-demand PrEP.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

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Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians

et al. 2021

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“…Similar findings have been seen in multiple settings in other studies as well. [22][23][24] Our PrEP interventions received significant support from nonprescribing clinic staff and trainees. The inclusion of multiple health care professions and ancillary support staff in this process is unique, but important to ensure widespread impact and ongoing success of PrEP in the homeless primary care setting.…”

Section: Discussionmentioning

confidence: 99%

Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

GREGG

Linn

Nace

et al. 2020

J Prim Care Community Health

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Objective: Oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV-1 acquisition, yet it is underutilized among at-risk populations. In this pilot quality improvement (QI) initiative, we sought to identify barriers to PrEP implementation and create interventions to improve access to PrEP in a primary care clinic for homeless veterans. Methods: The setting was a large homeless primary care clinic at the Veterans Affairs in an urban area with high HIV prevalence. A root cause analysis was performed to identify barriers to PrEP expansion in the primary care clinic. Targeted interventions to improve provider knowledge and patient access to PrEP were implemented by the QI team. Results: Root cause analysis revealed 3 primary barriers to PrEP expansion in the primary care clinic: institutional limitations for prescribing PrEP, inconsistent screening and recognition of eligible patients by clinic staff, and lack of clinic workflow processes to support PrEP prescription. A multidisciplinary focus group found low levels of PrEP awareness and knowledge, with only 22% of providers reporting comfort discussing PrEP with patients. This improved to 40% of providers following targeted clinic educational interventions. The QI team also developed a pathway for primary care providers to obtain institutional PrEP prescribing privileges and used work groups to develop clinic workflows and protocols for PrEP. At the end of the intervention, at least 50% of primary care providers in the clinic had initiated PrEP in a new patient. Conclusions: We describe a multidisciplinary QI model to implement PrEP within a primary care setting serving Veterans and persons experiencing homelessness. Our program successfully addressed provider knowledge deficits and improved primary care capacity to prescribe PrEP. The primary care clinic can be a viable and important clinical setting to improve access to PrEP for HIV prevention, especially for vulnerable populations.

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“…To date, most PrEP outreach efforts in the United States have focused on men who have sex with men. A concerted public health approach can utilize multi-level efforts to educate the general community, potential candidates, and health care providers about PrEP (38). However, outreach is directly related to accessibility and affordability.…”

Section: Discussionmentioning

confidence: 99%

“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: A qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

Przybyla

Cerulli

Wilson

et al. 2020

Preprint

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Background: Women’s rise in opioid use disorder has increased their presence in the criminal justice system and related risk behaviors for HIV infection. Although pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention treatment, uptake among this high-risk population has been particularly low. Considerably little is known about the interplay between justice-involved women with opioid use disorder and HIV prevention. The aim of this study was to explore PrEP knowledge, attitudes, and perceptions for personal and partner use among women participants in the nation’s first ever opiate intervention court program.Methods: The authors conducted semi-structured, in-depth interviews with 31 women recruited from an Opioid Intervention Court, a recent fast-track treatment response to combat overdose deaths. We utilized a consensual qualitative research approach to explore attitudes, perceptions, and preferences about PrEP from women at risk for HIV transmission via sexual and drug-related behavior and used thematic analysis methods to code and interpret the data. Results: PrEP interest and motivation were impacted by various factors influencing the decision to consider PrEP initiation or comfort with partner use. Three primary themes emerged regarding HIV risk perceptions, barriers and facilitators to personal PrEP utilization, and perspectives on PrEP use by sexual partners. Conclusions: Findings suggest courts may provide a venue to offer women PrEP education and HIV risk assessments. Study findings inform public health, substance use, and criminal justice research and practice with justice-involved participants experiencing opioid use disorder on the development of gender-specific PrEP interventions with the ultimate goal of reducing HIV incidence.

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Health Care Provider Perspectives on Pre-exposure Prophylaxis: A Qualitative Study

Cited by 16 publications

References 31 publications

Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians

Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians

Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: A qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program

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