Roadblocks to PrEP: What Medical Records Reveal About Access to HIV Pre-exposure Prophylaxis

Skolnik, Avy A.; Bokhour, Barbara G.; Gifford, Allen L.; Wilson, Brigid; Epps, Puja Van

doi:10.1007/s11606-019-05475-9

Cited by 37 publications

(42 citation statements)

References 26 publications

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“… 26 , 37 , 41 In our sample, over half of non-prescribers reported willingness to prescribe PrEP if a patient requested it, and almost every prescriber reported patient inquiry. A study of Veterans Affairs patients who received PrEP showed that 94% of PrEP conversations were patient-initiated and recipients were often already educated about PrEP at the time of request, 42 overall indicating that an undue burden may be being placed on patients to initiate conversations around PrEP.…”

Section: Discussionmentioning

confidence: 99%

Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

Moore

Kelly

Alexander

et al. 2020

J Prim Care Community Health

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Introduction/Objectives: Pre-exposure prophylaxis (PrEP) use in the southern United States is low despite its effectiveness in preventing HIV acquisition and high regional HIV prevalence. Our objectives were to assess PrEP knowledge, attitudes, and prescribing practices among Tennessee primary care providers. Methods: We developed an anonymous cross-sectional electronic survey from March to November 2019. Survey development was guided by the Capability, Opportunity, Motivation, and Behavior framework and refined through piloting and interviews. Participants included members of professional society and health center listservs licensed to practice in Tennessee. Respondents were excluded if they did not complete the question regarding PrEP prescription in the previous year or were not in a position to prescribe PrEP (e.g., hospital medicine). Metrics included PrEP prescription in the preceding year, PrEP knowledge scores (range 0-8), provider attitudes about PrEP, and provider and practice characteristics. Knowledge scores and categorical variables were compared across PrEP prescriber status with Wilcoxon rank-sum and Fisher’s exact tests, respectively. Results: Of 147 survey responses, 99 were included and 43 (43%) reported PrEP prescription in the preceding year. Compared with non-prescribers: prescribers had higher median PrEP knowledge scores (7.3 vs 5.6, P < .01), a higher proportion had self-reported patient PrEP inquiries (95% vs 21%, P < .01), and a higher proportion had self-reported good or excellent ability to take a sexual history (83% vs 58%, P = .01) and comfort taking a sexual history (92% vs 63%, P < .01) from men who have sex with men, a subgroup with high HIV risk. Most respondents felt obligated to provide PrEP (65%), and felt all primary care providers should provide PrEP (63%). Conclusion: PrEP provision is significantly associated with PrEP knowledge, patient PrEP inquiries, and provider sexual history taking ability and comfort. Future research should evaluate temporal relationships between these associations and PrEP prescription as potential routes to increase PrEP provision.

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Section: Discussionmentioning

confidence: 99%

Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

Moore

Kelly

Alexander

et al. 2020

J Prim Care Community Health

View full text Add to dashboard Cite

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“…However, we know from recent literature that routine HIV risk assessments by clinicians is a barrier to implementing PrEP [11], which could further impact identifying and engaging with priority populations vulnerable to HIV. A study published in 2019 further reinforced barriers related to confusion or disagreement over the clinical purview for PrEP, with patients being "bounced back and forth between primary care and HIV clinics" [23]. Other barriers noted included knowledge gaps and practitioner attitudes, or stigma associated with PrEP prescribing.…”

Section: Plos Onementioning

confidence: 99%

Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US

et al. 2020

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Background and objectives Less than 10 percent of the more than one million people vulnerable to HIV are using preexposure prophylaxis (PrEP). Practitioners are critical to ensuring the delivery of PrEP across care settings. In this study, we target a group of prescribers focused on providing HIV care and seeking up-to-date information about HIV. We assessed their experiences prescribing PrEP, whether these experiences differed by clinical specialty, and examined associations between willingness to prescribe PrEP as a "best first step" and different hypothetical prescribing scenarios.

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“…For the 7 years prior, HIV diagnoses had decreased overall by 11% among adults and adolescents, but increased among some patient populations, 12 which is why the primary goal for national HIV prevention continues to focus on reduction in new infections. 13 Between 2010 and 2016, rates of new HIV infection decreased by 6% with notable drops among heterosexuals, persons who inject drugs, and White men who have sex with men (MSM) but increased rates of infection for Hispanic/ Latino MSM and rates of infection among African American MSM remained unchanged. 14 Despite the success of PrEP, the widening gap in HIV prevention affecting Hispanic/Latino and African American MSM warrants a deeper exploration of the stigma and barriers impeding access and uptake of PrEP.…”

Section: Origins Of Prep Stigmamentioning

confidence: 99%

“…In regards to PrEP use and promotion of PrEP use among health professionals, there remain knowledge gaps that pose significant deterrents and place a substantial burden on patients wanting to request treatment. 13 These knowledge gaps in conjunction with structural and social determinants of health may help to shed light on the reason for disparities in PrEP usage among MSM and other marginalized patient communities.…”

Section: Origins Of Prep Stigmamentioning

confidence: 99%

“…Physician assessment of a patient's eligibility for PrEP use, concerns for adherence, and the likelihood of engaging in risk compensation may be influenced by social characteristics such as race contributing to health inequities. 26 Medical records of Veterans Health Administration (VHA) patients revealed attitudinal barriers in addition to provider knowledge gaps regarding PrEP usage in a study by Skolnick et al 13 A qualitative analysis of documented conversations with patients showed providers' preferences to focus on behavioral risk reduction strategies. Rather than prescribing, providers discouraged PrEP and would instead suggest limiting or even ceasing sexual activity.…”

Section: Sources Of Prep Stigmamentioning

confidence: 99%

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<p>Current Perspectives on the Impact of Pre-Exposure Prophylaxis Stigma Regarding Men Who Have Sex with Men in the United States</p>

Herron¹

2020

HIV

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Pre-exposure prophylaxis or PrEP is a Food and Drug Administration approved human immunodeficiency virus (HIV) prevention tool that reduces the risk of infection by greater than 90%. While it does not provide protection against other sexually transmittable infections and blood-borne illnesses such as hepatitis C, syphilis, chlamydia, and gonorrhea, it is a highly effective in reducing the risk of transmission of HIV among men who have sex with men. Despite the success of PrEP, there remain barriers to PrEP uptake rooted in stigmatized perspectives shared by health professionals, patients, and community members. The insidious impact of stigma associated with HIV/AIDS has permeated throughout the LGBTQ+ community, healthcare system, society in general and to this day, continues to exacerbate structural and social determinants of health disparities amongst sexual and gender minorities. While the initial resistance to PrEP has abated over time, stigmatized perspectives regarding PrEP continue to impede those at greatest risk from benefiting from effective preventive care.

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Roadblocks to PrEP: What Medical Records Reveal About Access to HIV Pre-exposure Prophylaxis

Cited by 37 publications

References 26 publications

Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US

<p>Current Perspectives on the Impact of Pre-Exposure Prophylaxis Stigma Regarding Men Who Have Sex with Men in the United States</p>

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