HIV Care Providers' Intentions to Prescribe and Actual Prescription of Pre-Exposure Prophylaxis to At-Risk Adolescents and Adults

Next-generation forms of HIV pre-exposure prophylaxis (PrEP) currently in development, including long-acting injectables (LAIs), rectal microbicides (RMs), antibody infusions (AIs), and subdermal implants (SIs), may address barriers to daily oral PrEP uptake and adherence. The purpose of this study was to evaluate barriers to oral PrEP, preferences for next-generation PrEP modalities, sociodemographic characteristics and sexual behaviors associated with preferences, and reasons for wanting or not wanting each formulation among a sample of men who have sex with men (MSM). We administered a cross-sectional survey to a diverse sample of MSM currently taking oral PrEP (n = 108) at two sexually transmitted disease clinics. We used logistic multivariate analyses to explore preferences, relative to oral PrEP, for each formulation across sociodemographic and sexual behaviors. The most commonly endorsed barriers were finding a PrEP provider and making appointments to get PrEP. Participants were most likely to prefer the SI (45%), followed by the LAI (31%), pill (21%), RM (1%), and AI (1%). Black/African American and Hispanic/Latino MSM were more likely to prefer the LAI over daily oral PrEP (odds ratio: 2.45, 95% confidence interval: 0.86-6.89), and sexual behaviors were most commonly associated with preference for the SI. Top reasons for wanting or not wanting each formulation were most commonly related to perceived ease of use. These findings demonstrate variations in preferences for next-generation PrEP modalities, highlighting a need to ensure comprehensive access to all formulations once they become available.

Section: Discussionmentioning

confidence: 93%

Next-Generation HIV Pre-Exposure Prophylaxis Preferences Among Men Who Have Sex with Men Taking Daily Oral Pre-Exposure Prophylaxis

Ellison

Berg

Montgomery

et al. 2019

“…Studies have shown that primary care providers are more willing to discuss PrEP with MSM than PWID, 59 while nurse practitioners may be more willing to prescribe PrEP to heterosexuals. 60 However, due to stigma and resulting reluctance to attend medical appointments, 56 PWID may have limited contact with primary care providers, and addiction specialists may have low knowledge of, or ambivalence about, PrEP. 61 Improving providers' knowledge, comfort, and willingness to discuss PrEP and sensitive HIV risk behaviors (both sexual and injection-related) with PWID will also be required to promote PrEP uptake in this population.…”

Section: Discussionmentioning

confidence: 99%

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs

Bazzi

Biancarelli

Childs

et al. 2018

People who inject drugs (PWID) experience sexual and injection-related HIV risks, but uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among PWID has been low. Improving PrEP uptake in this population will require understanding of PrEP knowledge and interest. In 2017, we conducted in-depth, semistructured interviews with HIV-uninfected PWID and key informants (PrEP and harm reduction providers) in the US Northeast. Thematic analysis of coded data explored PrEP knowledge and the factors that influence PrEP interest. Among PWID (n = 33), median age was 36 years, 55% were male, 67% were white, and 24% identified as Hispanic/Latino. Accurate PrEP knowledge among PWID was low, which key informants (n = 12) attributed to PrEP marketing focused on other risk populations, as well as healthcare providers' lack of time and unwillingness to discuss PrEP with PWID. There was a discrepancy between self-reported HIV risk behaviors, which were common, and HIV risk perceptions, which varied and strongly influenced PrEP interest. Most PWID and key informants thought that PrEP would be most beneficial for those who shared syringes, used discarded syringes, engaged in transactional sex, or were homeless. Improving uptake of PrEP for HIV prevention among high-risk PWID will require education to increase PrEP knowledge and addressing factors that negatively influence PrEP interest such as perceptions regarding low HIV risk and the process for obtaining PrEP. This may require specialized PrEP marketing and outreach efforts and improved capacity of healthcare providers to effectively assess HIV risk (and perceptions) and communicate the benefits of PrEP to at-risk PWID.

“…Of the 28 articles included in our systematic review, 18 studies reported lack of provider knowledge as a barrier to PrEP prescription. 24,[26][27][28]31,32,34,38,[40][41][42][43][44][45][46][47]49 PrEP awareness among PCPs increased steadily, from 24% to 66% between 2009 and 2015. 44 However, PrEP knowledge remained low, with only 17% of providers indicating that they had read the CDC guidelines in 2014.…”

Section: Lack Of Knowledgementioning

confidence: 99%

“…28 However, one study found that lower endorsement of cost and insurance factors was associated with higher intentions to prescribe PrEP. 40…”

Section: Concerns About Costmentioning

confidence: 99%

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

Pleuhs

Quinn

Walsh

et al. 2020

156

128

Increasing prescription of pre-exposure prophylaxis (PrEP) is imperative to ending the HIV epidemic in the United States. The objective of this review was to identify health care provider barriers to PrEP implementation. A systematic review was conducted in February 2019 using PubMed to identify barriers to PrEP prescribing practices in the United States. Targeted search terms surrounding PrEP and providers resulted in 222 original studies, 28 of which were ultimately included in our review, with data collected between 2011 and 2018. Six themes were identified across reviewed studies: (i) a lack of PrEP knowledge, (ii) the presence of the Purview Paradox, which refers to discordance in beliefs between HIV specialists and primary care providers on who should prescribe PrEP, (iii) concerns about PrEP costs, (iv) concerns about behavioral and health consequences, (v) interpersonal stigma, and (vi) concerns about patient adherence. A majority of providers were lacking knowledge regarding PrEP, resulting in discomfort in prescribing PrEP, or limited awareness and understanding of PrEP clinical guidelines. Discrepant opinions were identified regarding whether PrEP was best managed within primary care or specialty clinics. Other barriers included concerns about cost, patient adherence, and follow-up maintenance care. Finally, concerns about risk compensation and discomfort discussing sexual activities with patients who would benefit most from PrEP were apparent. Additional work is needed to prepare providers to prescribe and manage patients on PrEP, optimize PrEP delivery, and reduce provider bias. Future research is needed to identify providers' attitudes and beliefs regarding innovations in PrEP dosing, task shifting, and novel strategies for PrEP care.