How Do Family Physicians Perceive Their Role in Providing Pre-exposure Prophylaxis for HIV Prevention?–An Online Qualitative Study in Flanders, Belgium

Abstract

Introduction:In Belgium, the provision of pre-exposure prophylaxis (PrEP) for HIV prevention is centralized in specialized HIV clinics. Engaging family physicians in PrEP care could help scale-up its delivery and reach underserved populations. The objective of this study was to gain insight into family physicians' self-perceived roles in providing PrEP.MethodsWe conducted 16 online group discussions with a total of 105 Flemish family physicians, between November 2020 and February 2021. A brief online questionnaire assessed their socio-demographics and experience with sexual health. We analyzed verbatim transcribed data using a grounded theory approach.ResultsDespite limited awareness and experience, participants reported a high willingness to be more actively involved in PrEP care. Four potential roles for the family physician in PrEP care were identified: acting as low-threshold entry point for advice; opportunistic case finding of PrEP candidates; initiating appropriate care for PrEP-eligible clients; and ensuring high-quality follow-up care for PrEP users. Participants framed each of these roles within their current activities and responsibilities as primary care providers. Yet, participants differed in their views on the concrete operationalization of these roles, and in the extent of their involvement in PrEP. Particular challenges were a lack of experience with antiretrovirals, perceived limited exposure to clients at high HIV risk, and a lack of expertise and resources to conduct time-intensive risk assessments and counseling related to PrEP.ConclusionBelgian family physicians demonstrated a keen willingness to be involved in PrEP care, but had differing views on the practical implementation into their practices. Providing tailored training on sexual health and PrEP, and investing in collaboration between primary and secondary care, could optimize the integration of PrEP in the primary care practice.

Prescribing pre-exposure prophylaxis (PrEP) for HIV prevention: A cross-sectional survey of General Practitioners in Australia

“…The top three barriers that impacted our Australian GPs participants prescribing of PrEP were difficulty identifying clients who would benefit from PrEP, lack of knowledge regarding PrEP, and lack of time to adequately counsel regarding PrEP. These results are comparable with the literature, with the main barriers identified in studies as lack of knowledge regarding PrEP and difficulty identifying clients at risk of HIV (8, 10, 11, 12, 19). Difficulty identifying clients who would benefit from PrEP could be addressed by having GP clinics collect certain demographics as part of client registration.…”

“…Past studies have identified several barriers to PrEP prescribing among GPs. Barriers include lack of knowledge regarding PrEP, inability to identify clients at risk of HIV, and concern that PrEP use may increase the incidence of other STIs (8, 9, 10, 11, 12). An Australian GP questionnaire found the main barriers to PrEP prescribing were lack of experience with antiretrovirals and lack of guidelines for prescription (13).…”

Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an implementation science framework

“…Such initiatives will distribute the workload more evenly across health system actors, improve (timely) access to PrEP and ensure more client‐centred care. In particular, previous research in Belgium shows that FPs are willing to be more involved in PrEP care, and that about half of the PrEP users would accept follow‐up visits with their FP [52, 57]. While we observed the emergence of informal collaborative care models between specialized services and FPs in at least one HIV clinic, other clinics were waiting for such models to be first legitimized by reimbursement regulations before implementing them.…”

Epidemiological impact and cost-effectiveness of expanding formal PrEP provision to PrEP-eligible MSM expressing PrEP-intention in the Netherlands

“…To address this, a centralised PrEP registry should be established, and a de-centralisation of PrEP provisions to encourage other medical doctors, including GPs, deems necessary and should be implemented. These approaches align with practices in other European countries like France [10] and Belgium [21], and the elimination programmes of other STIs, such as hepatitis C virus [22]. In turn, the formal provision and uptake of PrEP would be enhanced to support ending the HIV epidemic.…”