Public Health Detailing to Promote HIV Pre- and Postexposure Prophylaxis Among Women's Healthcare Providers in New York City

Abstract

Introduction:Equitable access to HIV pre-and postexposure prophylaxis for women is essential to ending the HIV epidemic. Providers' lack of knowledge and comfort in discussing and prescribing pre-exposure prophylaxis to women persist as barriers.Methods: From May to November 2019, the New York City Health Department conducted its first public health detailing campaigns among women's healthcare providers to promote pre-and postexposure prophylaxis and the associated best practices. Over 2 campaigns (10 weeks each), trained Health Department representatives visited providers for 1-on-1 visits at select practices to promote key messages. Representatives distributed an Action Kit that addressed knowledge gaps and practice needs on providing pre-exposure prophylaxis and postexposure prophylaxis to cisgender and transgender women. Providers completed an assessment at the beginning of initial and follow-up visits, used to compare responses across visits. Statistically significant changes were evaluated by generalized linear models of bivariate outcomes, adjusted for nonindependence of providers at the same practice. Results:Representatives visited 1,348 providers specializing in primary care (47%), women's health (30%), adolescent health (7%), infectious disease (4%), and other (12%) at 860 sites; 1,097 providers received initial and follow-up visits. Provider report of ever prescribing pre-exposure prophylaxis increased by 12% (n=119 providers); increases were reported in measures of taking sexual history, asking about partners' HIV status, providing postexposure prophylaxis, recognizing preexposure prophylaxis's effectiveness, and discussing and referring for pre-exposure prophylaxis.Conclusions: After public health detailing, women's healthcare providers report increased adoption of recommended practices that promote pre-and postexposure prophylaxis uptake and sexual wellness among women. Detailing may be adaptable to other regions and contexts to reach providers.

Strategies to Eliminate Inequity in PrEP Services in the US South and Rural Communities

“…To (Wahnich et al, 2021), a structural PrEP intervention to improve PrEP access. In this intervention, trained health department representatives introduced an "Action Kit," including U.S. Public Health Service's PrEP clinical practice guideline to 1,348 medical providers at women's health clinics in New York City.…”

“…Positive findings from the PrEP and PEP Public Health Detailing Campaign for Cisgender and Transgender Women (Wahnich et al, 2021) and Project SHE (Roth et al, 2021) suggest that better PrEP access may be achieved when providers, who have established trusted relationships with patients who are PrEP candidates, proceed and prescribe PrEP directly instead of referring their patients who are candidates for PrEP to HIV specialists. To expand PrEP services, the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC) is implementing the Ending the HIV Epidemic (EHE)-Primary Care HIV Prevention (PCHP) project.…”

“…As of September 2023, 13 best practices (i.e., interventions and strategies with the strongest efficacy [evidence-based or EBI] or some evidence [evidence-informed or EI]) have been identified in the Compendium to improve PrEP uptake and persistence. One of these best practices is the PrEP and PEP Public Health Detailing Campaign for Cisgender and Transgender Women (Wahnich et al, 2021), a structural PrEP intervention to improve PrEP access. In this intervention, trained health department representatives introduced an “Action Kit,” including U.S. Public Health Service's PrEP clinical practice guideline to 1,348 medical providers at women's health clinics in New York City.…”

New USPSTF Guidelines for HIV Preexposure Prophylaxis

“…17 The 2023 USPSTF guidelines 3 point to a number of structural barriers to PrEP implementation and uptake, and novel approaches are needed to address these barriers. Clinicians may benefit from public health detailing (educational outreach from health department representatives) on available PrEP options and how to prescribe them and counsel patients 18 and from support tools such as electronic health record algorithms to identify persons at risk for HIV acquisition. 19 Additionally, shifting tasks from physicians to PrEP navigators or nurses could increase efficiencies and help expand PrEP access.…”

Improving HIV preexposure prophylaxis implementation within healthcare settings

“…The paradox in PrEP prescription patterns suggests that HIV specialists are the most informed and experienced in prescribing antiretroviral treatment (ART) and PrEP, but primary care providers and others, such as obstetricians/gynecologists and emergency medicine providers, are the specialists who are more likely to encounter the HIV-negative individuals who would benefit from PrEP [10,11]. PrEP guidelines, conferences, webinars, training modules, and public health detailing have improved HIV specialists’ and primary care providers’ knowledge of and willingness to prescribed PrEP [12,13]. Studies have shown that the number of HIV specialists and primary care providers who prescribe PrEP in the United States has risen steadily but remains insufficient [14,15].…”