Understanding the role of nurse practitioners, physician assistants and other nursing staff in HIV pre-exposure prophylaxis care in the United States: a systematic review and meta-analysis

Abstract

Background Although pre-exposure prophylaxis (PrEP) was approved for primary HIV prevention by the Federal Drug Administration in 2012, PrEP utilization has been suboptimal. A body of literature and programs has emerged to examine the role of nurse practitioners (NPs), physician assistants and nursing staff in PrEP care. This review aims to understand the current status of non-physician health providers in PrEP care implementation in the United States. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, we conducted a comprehensive literature search using multiple databases to identify peer-reviewed articles that examined the role of non-physician health providers in the implementation of PrEP. Four major databases of studies using observational study design, randomized control trials and mixed-method study design were screened from November 2019 to January 2020 were searched. Two independent reviewers examined eligibility and conducted data extraction. We employed random-effects model aims to capture variances of estimates across studies. Results A total of 26 studies with 15,789 health professionals, including NPs (18, 95% CI = 14,24%), physician assistants (6, 95% CI = 2, 10%), nursing staff (26, 95% CI = 18–34%), and physicians (62,95% CI = 45, 75%), were included in the analysis. The odds of prescribing PrEP to patients among NPs were 40% (OR = 1.40, 95% CI = 1.02,1.92) higher than that among physicians, while the likelihood of being willing to prescribe PrEP was similar. On the other hand, the odds of being aware of PrEP (OR = 0.63, 95% CI = 0.46, 0.87) was 37% less in nursing professionals than that among physicians. Conclusions Although the limited number and scope of existing studies constrained the generalizability of our findings, the pattern of PrEP care implementation among non-physician health providers was described. To achieve wider PrEP care implementation in the U.S., increasing awareness of PrEP among all health providers including both physicians and non-physicians is a key step.

Implementation of a Standardized National HIV Curriculum in a Primary Care Nurse Practitioner Program

“…However, awareness of strategies such PrEP have been found to be lower among NPs than among physicians. 8 Although completion of the NHC only had a small effect on students' intent to working with PLWH, this may be due to the perception that PLWH are referred to specialty clinics for management of their HIV diagnosis and co-occurring conditions. Students may have not viewed HIV care on a continuum where PLWH also need primary care services such as immunizations and management of other acute and chronic conditions.…”

“…The need for standardized HIV education in NP programs is further highlighted by persistent gaps in knowledge related to HIV prevention including testing behaviors and pre-exposure prophylaxis (PrEP) among NPs. 8,11 In an effort to address these providers' gaps in knowledge, the AIDS Education and Training Center Program, in collaboration with the University of Washington and Health Resources and Service Administration (HRSA), developed a National HIV Curriculum (NHC) to address the HRSA national strategic goal of increasing access to care and optimizing health outcomes for PLWH. 12 The primary aim of the NHC is to increase the number of health care professionals who can competently provide care for PLWH by providing up-to-date, evidence-based standardized curriculum related to HIV screening, diagnosis, ongoing treatment, and prevention.…”

“…Although efforts have been made to improve and integrate HIV curriculum in schools of nursing,9,10 little has been done to standardize the integration of HIV curriculum and competencies related to HIV care in primary care NP programs. The need for standardized HIV education in NP programs is further highlighted by persistent gaps in knowledge related to HIV prevention including testing behaviors and pre-exposure prophylaxis (PrEP) among NPs 8,11…”

Scaling up access to HIV pre-exposure prophylaxis (PrEP): should nurses do the job?

“…21 A recent systematic review of studies from the USA concluded that nurses were 40% more likely than doctors to prescribe PrEP. 22 Experience from task sharing of ART shows that clients often prefer receiving care closer to their homes, 23 and that this preference translates into improved retention in care and long-term clinical outcomes when care is decentralised. 5 Task sharing can also improve the cost-effectiveness and efficiency of health systems.…”

Scaling up preexposure prophylaxis to maximize HIV prevention impact

“…The Kenyan Ministry of Health has named research on pharmacy PrEP as a high priority [39]. Nurse-led PrEP delivery in sexual health services has been trialled successfully in several settings [40,41], and in one study, nurse prescribers were more likely than physicians to prescribe PrEP [42].…”