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Oot A, Kapadia F, Moore B, Greene RE, Katz M, Denny C, Pitts R. A mixed-methods evaluation of an HIV pre-exposure prophylaxis educational intervention for healthcare providers in a NYC safety-net hospital-based obstetrics and gynecology clinic. AIDS Care 2024; 36:1537-1544. [PMID: 38943674 DOI: 10.1080/09540121.2024.2364218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/31/2024] [Indexed: 07/01/2024]
Abstract
Cisgender women and transgender men are less likely to be assessed for PrEP eligibility, prescribed PrEP, or retained in PrEP care. Thus, this pilot PrEP educational intervention was tailored for healthcare providers (HCPs) in obstetrics/gynecology who provide care to cisgender women and transgender men in an academically-affiliated, public hospital women's health clinic. The three-lecture educational curriculum designed for HCPs focused on PrEP eligibility and counseling, formulations and adherence, and prescription and payment assistance programs. Pre- and post-intervention surveys assessed HCP knowledge and barriers to PrEP counseling and prescription. Among n = 49 participants (mean age = 32.8 years; 85.7% cisgender women, mean years practicing = 4.2 years) pre-intervention, 8.7% had prior PrEP training and 61.2% felt very/somewhat uncomfortable prescribing PrEP. Post-intervention, knowledge of PrEP contraindications, eligibility, follow-up care, and assistance programs all increased. HCPs identified key barriers to PrEP care including lack of a dedicated PrEP navigator, culturally and linguistically appropriate patient materials on PrEP resources/costs, and PrEP-related content integrated into EHRs. Ongoing PrEP educational sessions can provide opportunities to practice PrEP counseling, including information on financial assistance. At the institutional level, incorporating PrEP screening in routine clinical practice via EMR prompts, facilitating PrEP medication monitoring, and enhancing telehealth for follow-up care could enhance PrEP prescription.
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Affiliation(s)
- Antoinette Oot
- Department of Obstetrics & Gynecology, NYU Langone Health and NYC Health and Hospitals/Bellevue, New York, NY, USA
| | - Farzana Kapadia
- Department of Epidemiology, NYU School of Global Public Health, New York, NY, USA
| | - Brandi Moore
- Department of Epidemiology, NYU School of Global Public Health, New York, NY, USA
| | - Richard E Greene
- Department of Internal Medicine, NYU Langone Health and NYC Health and Hospitals/Bellevue, New York, NY, USA
| | - Melinda Katz
- Department of Internal Medicine, NYU Langone Health and NYC Health and Hospitals/Bellevue, New York, NY, USA
| | - Colleen Denny
- Department of Obstetrics & Gynecology, NYU Langone Health and NYC Health and Hospitals/Bellevue, New York, NY, USA
| | - Robert Pitts
- Department of Internal Medicine, NYU Langone Health and NYC Health and Hospitals/Bellevue, New York, NY, USA
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Lockhart E, Turner D, Guastaferro K, Szalacha LA, Alzate HT, Marhefka S, Pittiglio B, Dekker M, Yeh HH, Zelenak L, Toney J, Manogue S, Ahmedani BK. Increasing pre-exposure prophylaxis (PrEP) in primary care: A study protocol for a multi-level intervention using the multiphase optimization strategy (MOST) framework. Contemp Clin Trials 2024; 143:107599. [PMID: 38848935 DOI: 10.1016/j.cct.2024.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/14/2024] [Accepted: 06/01/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND In the United States, over 1.2 million people are living with HIV. This disease disproportionately affects men who have sex with men (MSM), people of color, youth and young adults, and transgender individuals. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method. Barriers exist for both primary care providers (PCPs) to prescribe PrEP and prevent patients from initiating PrEP. METHODS This study, MOST: PrEP, follows the multiphase optimization strategy (MOST) framework. The purpose is to identify a multi-level intervention among patients and PCPs to increase PrEP prescriptions in primary care. First, feedback will be obtained from providers and patients via focus groups, then, suggestions related to the context-specific (provider and individual level) factors of intervention component delivery will be incorporated. Subsequently, a rigorous experiment will be conducted using a 24 factorial design focusing on priority populations for PrEP initiation. Provider components include computer-based simulation training and a best practice alert. Patient components include a tailored PrEP educational video and HIV risk assessment. Finally, the facilitators and barriers to implementing the intervention components will be qualitatively examined. CONCLUSION In this protocol paper, we describe the one of the first known multilevel MOST optimization trial in healthcare. Intervention components are to be delivered to patients and providers in a large healthcare system, based in an HIV Ending the Epidemic priority jurisdiction. If effective, this multi-level approach could be disseminated to providers and patients in other large healthcare systems to make a significant impact on HIV prevention.
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Affiliation(s)
- Elizabeth Lockhart
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - DeAnne Turner
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 6th Floor Room 636, New York, NY 10003, USA.
| | | | - Herica Torres Alzate
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Stephanie Marhefka
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Bianca Pittiglio
- Family Medicine, Henry Ford Health, 110 E 2nd Street, Royal Oak, MI 48067, USA.
| | - Megan Dekker
- Academic Internal Medicine, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI 48202, USA.
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Logan Zelenak
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Jeremy Toney
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Sean Manogue
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
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Nacht CL, Reynolds HE, Jessup O, Amato M, Storholm ED. The Association between Social Support and Pre-Exposure Prophylaxis use among Sexual Minority Men in the United States: A Scoping Literature Review. AIDS Behav 2024:10.1007/s10461-024-04446-4. [PMID: 39039399 DOI: 10.1007/s10461-024-04446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
Sexual minority men (SMM) are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is an effective way of reducing HIV incidence, PrEP use has remained relatively low. Social support may be one effective factor in increasing PrEP use among SMM, but the association between social support and PrEP use/adherence is not well understood. The objective of this paper was to summarize the current literature on the association of social support and PrEP use among SMM in the United States. A systematic search was conducted using six different databases MEDLINE / PubMed, PsycINFO, Cochrane CENTRAL, Google Scholar, Embase, and Web of Science using terms established from keywords and medical subject headings (MeSH) terms before being adapted to each database. Data were extracted for key study factors (e.g., study population, geographic location, study design) and main findings. This search produced eleven articles: ten manuscripts and one conference abstract. Of these, two were randomized control trials, two were interventions, three were qualitative, and four were cross-sectional. The studies were widespread across the country, but most were in major metropolitan areas. From the articles included in this review, findings were inconsistent in the association between social support; some studies showed null findings, others that only certain sources of social support were significant, and others that there was a significant association between social support and PrEP use. This review highlights the complexity of the relationship between social support and PrEP use among SMM, indicating the need for further research to identify specific types and sources of support that effectively enhance PrEP uptake and adherence. Targeted interventions based on these insights could significantly reduce HIV incidence in the population.
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Affiliation(s)
- Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, San Diego, CA, USA.
| | - Hannah E Reynolds
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Owen Jessup
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Marianna Amato
- College of Education, San Diego State University, San Diego, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
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Gomez B, Roozkhosh F, Yao A, Chastain DB, Johnson BR. Examining the potential of pharmacies to expand pre-exposure prophylaxis access along Georgia's fixed-route public transit: A geospatial analysis. J Am Pharm Assoc (2003) 2024; 64:102087. [PMID: 38583710 DOI: 10.1016/j.japh.2024.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Despite accounting for more than half of new Human Immunodeficiency Virus diagnoses in the United States, the South has fewer than 30% of all pre-exposure prophylaxis users. Pre-exposure prophylaxis access geospatial analyses have focused on drive time but analyses along public transit routes have not been evaluated. Given the proximity to pharmacists and pharmacies, involvement in pre-exposure prophylaxis services may increase access and uptake of this preventative health need. OBJECTIVE The objectives were to compare the rate of pre-exposure prophylaxis uptake between Georgia counties with and without public transit, to assess the geospatial accessibility of services along public transit, and to evaluate the potential impact of expanding pre-exposure prophylaxis services to community pharmacies. METHODS Pre-exposure prophylaxis uptake rates between counties with and without public transit were compared using the Mann-Whitney U test. Geospatial analysis was performed using ArcGIS Pro and Geoda. The Pearson correlation coefficient was used to determine the relationship between pre-exposure prophylaxis uptake rates and population and county characteristics. Spatial analysis was completed to uncover predictors for pre-exposure prophylaxis uptake rates. Increased access to pre-exposure prophylaxis along public transit was calculated by reporting the number of counties that would experience at least a 50% increase in pre-exposure prophylaxis access through community pharmacies. RESULTS Pre-exposure prophylaxis uptake is significantly higher in Georgia counties with versus without public transit (P < 0.001). Pre-exposure prophylaxis rate is positively correlated with the accessibility of community pharmacies and pre-exposure prophylaxis clinics along fixed-route public transit (R2 = 0.524). Among pre-exposure prophylaxis clinics, 44% are inaccessible by public transit alone. Community pharmacies are significantly more widely distributed and accessible along public transit routes than pre-exposure prophylaxis clinics. CONCLUSION Transportation remains a barrier to accessing pre-exposure prophylaxis. Georgia community pharmacies along public transit may serve as a solution to pre-exposure prophylaxis care access barriers.
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Kaptchuk RP, Thomas AM, Dhir AM, Solomon SS, Clipman SJ. Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland. BMC Public Health 2024; 24:1258. [PMID: 38720248 PMCID: PMC11077778 DOI: 10.1186/s12889-024-18595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The approval of long-acting pre-exposure prophylaxis PrEP (LA-PrEP) in the United States brings opportunities to overcome barriers of oral PrEP, particularly among sexual and gender minority communities who bear a higher HIV burden. Little is known about real-time decision-making among potential PrEP users of LA-PrEP post-licensure. METHODS We held focus group discussions with people assigned male at birth who have sex with men in Baltimore, Maryland to explore decision-making, values, and priorities surrounding PrEP usage. A sexual and gender minority-affirming health center that provides PrEP services supported recruitment. Discussions included a pile-sorting activity and were audio-recorded. Recordings were transcribed and analyzed iteratively, combining an inductive and deductive approach. RESULTS We held five focus groups from Jan-June 2023 with 23 participants (21 cisgender men who have sex with men, two transgender women who have sex with men; mean age 37). Among participants, 21 were on oral PrEP, one was on injectable PrEP, and one had never taken PrEP. Most had never heard about LA-PrEP. When making decisions about PrEP, participants particularly valued efficacy in preventing HIV, side effects, feeling a sense of security, and ease of use. Perceptions varied between whether oral or injectable PrEP was more convenient, but participants valued the new opportunity for a choice in modality. Factors influencing PrEP access included cost, individual awareness, provider awareness, and level of comfort in a healthcare environment. Participants emphasized how few providers are informed about PrEP, placing the burden of being informed about PrEP on them. Comfort and trust in a provider superseded proximity as considerations for if and where to access PrEP. CONCLUSIONS There is still low awareness about LA-PrEP among sexual and gender minority communities; thus, healthcare providers have a critical role in influencing access to LA-PrEP. Despite this, providers are still vastly underinformed about PrEP and underprepared to support clients in contextualized ways. Clients are more likely to engage in care with affirming providers who offer non-judgmental conversations about sex and life experiences. Provider education in the United States is urgently needed to better support clients in choosing a PrEP modality that is right for them and supporting adherence for effective HIV prevention.
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Affiliation(s)
| | - Amber M Thomas
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sunil S Solomon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mekonnen G, Liknaw T, Anley A, Afenigus AD. Knowledge, attitudes, and associated factors towards HIV pre-exposure prophylaxis among health care providers. Sci Rep 2024; 14:6168. [PMID: 38485990 PMCID: PMC10940609 DOI: 10.1038/s41598-024-56371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
The knowledge and attitudes of health care providers were limited as reviewed in many studies. Attitudes and knowledge about pre-exposure prophylaxis among healthcare providers have not been investigated in Ethiopia even though pre-exposure prophylaxis is a novel healthcare topic. The aim was to assess knowledge, attitudes, and associated factors towards pre-exposure prophylaxis among healthcare providers in Gojjam health facilities, North West Ethiopia, 2022. An institutional-based cross-sectional study was conducted from June 1-30 among 410 healthcare providers in public health facilities in the East Gojjam zone. A simple random sampling technique was used to recruit the required study participants. The statistical program EPI Data version 4.6 was used to enter the data, and statistical packages for Social science version 25 was used for analysis. Variables with a p-value less than 0.25 in the bivariable analysis were included in the multivariable logistic regression analysis. Statistical significance was determined with a p-value less than 0.05. The good knowledge and the favorable attitude of healthcare providers toward HIV pre-exposure prophylaxis were 55.7% (50.6-60.2%) and 60.2% (55.0-65.0%) respectively. male participant (AOR 1.67; 95% CI (1.01-2.55), service year ≥ 10 years (AOR 2.52; 95% CI (1.23-5.17), favorable attitudes (AOR 1.92; 95%CI (1.25-2.95), and providers good sexual behavior (AOR 1.85; 95%CI (1.21-2.82) were significantly associated with the good knowledge, and training (AOR 2.15; 95% CI (1.23-3.76), reading the guideline (AOR 1.66; 95% CI (1.02-2.70), and good knowledge (AOR 1.78; 95% CI (1.16-2.75) was significantly associated with the favorable attitudes. In general, the finding of this study shows that the knowledge and attitudes of healthcare providers were low. Since this is a new initiative their knowledge is lower than their attitudes. Male, service year 10 years, and good provider sexual behavior were factors significantly associated with good knowledge. Training, reading the guidelines, and good knowledge were factors significantly associated with a favorable attitudes. As a result, healthcare facilities intervention programs and strategies better target these factors to improve the knowledge and attitudes of healthcare providers. Preparing training programs to enhance knowledge and attitudes towards PrEP is recommended.
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Affiliation(s)
- Getachew Mekonnen
- Department of Nursing, Shebel Berenta Hospital, Shebel Berenta, Ethiopia.
| | - Tiliksew Liknaw
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alemayehu Anley
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abebe Dilie Afenigus
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Devlin SA, Johnson AK, Stanford KA, Haider S, Ridgway JP. "There hasn't been a push to identify patients in the emergency department"-Staff perspectives on automated identification of candidates for pre-exposure prophylaxis (PrEP): A qualitative study. PLoS One 2024; 19:e0300540. [PMID: 38483939 PMCID: PMC10939190 DOI: 10.1371/journal.pone.0300540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Automated algorithms for identifying potential pre-exposure prophylaxis (PrEP) candidates are effective among men, yet often fail to detect cisgender women (hereafter referred to as "women") who would most benefit from PrEP. The emergency department (ED) is an opportune setting for implementing automated identification of PrEP candidates, but there are logistical and practical challenges at the individual, provider, and system level. In this study, we aimed to understand existing processes for identifying PrEP candidates and to explore determinants for incorporating automated identification of PrEP candidates within the ED, with specific considerations for ciswomen, through a focus group and individual interviews with ED staff. From May to July 2021, we conducted semi-structured qualitative interviews with 4 physicians and a focus group with 4 patient advocates working in a high-volume ED in Chicago. Transcripts were coded using Dedoose software and analyzed for common themes. In our exploratory study, we found three major themes: 1) Limited PrEP knowledge among ED staff, particularly regarding its use in women; 2) The ED does not have a standardized process for assessing HIV risk; and 3) Perspectives on and barriers/facilitators to utilizing an automated algorithm for identifying ideal PrEP candidates. Overall, ED staff had minimal understanding of the need for PrEP among women. However, participants recognized the utility of an electronic medical record (EMR)-based automated algorithm to identify PrEP candidates in the ED. Facilitators to an automated algorithm included organizational support/staff buy-in, patient trust, and dedicated support staff for follow-up/referral to PrEP care. Barriers reported by participants included time constraints, hesitancy among providers to prescribe PrEP due to follow-up concerns, and potential biases or oversight resulting from missing or inaccurate information within the EMR. Further research is needed to determine the feasibility and acceptability of an EMR-based predictive HIV risk algorithm within the ED setting.
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Affiliation(s)
- Samantha A. Devlin
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, United States of America
| | - Amy K. Johnson
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Kimberly A. Stanford
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Sadia Haider
- Department of Medicine, Section of Obstetrics and Gynecology, Rush University, Chicago, Illinois, United States of America
| | - Jessica P. Ridgway
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, United States of America
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Li LX, Lin JS, Tackett S, Bertram A, Sisson SD, Rastegar D, Berkenblit G. Knowledge of Pre- and Postexposure Prophylaxis for HIV Prevention Among Internal Medicine Residents in the United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:48-59. [PMID: 38349354 DOI: 10.1521/aeap.2024.36.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prescription rates of pre-exposure prophylaxis (PrEP) have remained low among noninfectious disease providers in the United States despite almost a decade since their introduction. For future primary care doctors, residency is the optimal time to build practice patterns around HIV prevention. We assessed baseline knowledge of PrEP in specific pre- and post-exposure prophylaxis content areas among internal medicine trainees who completed the Physician Education and Assessment Center HIV learning module between 2013 to 2020 (N = 12,060). Resident baseline PrEP knowledge was universally low; despite rising awareness of antiretroviral therapy for PrEP in successive years following the nadir of 41% in 2014, still only 56% of residents affirmed this means of HIV prevention by 2020. Knowledge remained limited regardless of academic year, local HIV prevalence, or training program type. Online module completion increased competence across all content areas. There is still a deficit in HIV prevention knowledge across U.S. internal medicine residents, suggesting insufficient education and exposure to HIV-related care.
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Affiliation(s)
- Lucy X Li
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica S Lin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean Tackett
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, and Department of Medicine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda Bertram
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen D Sisson
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darius Rastegar
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gail Berkenblit
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kasal N, Devlin S, Johnson AK, Dawdani A, Enaholo OE, Liegeon G, Pyra M, Hirschhorn LR, Haider S, Ducheny K, Simon J, Ridgway JP. Increasing providers' PrEP prescription for Black cisgender women: A qualitative study to improve provider knowledge and competency via PrEP training. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241277974. [PMID: 39245949 PMCID: PMC11382236 DOI: 10.1177/17455057241277974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
BACKGROUND Awareness and uptake of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) remains low among Black/African American cisgender women, partly due to low self-reported PrEP knowledge and comfort among primary care providers. Ensuring providers are trained on PrEP is crucial, as increased PrEP knowledge is associated with higher rates of PrEP prescription. OBJECTIVE We aimed to develop a PrEP training for providers to improve their self-efficacy in discussing and prescribing PrEP for Black women, with the ultimate goal of increasing PrEP awareness and utilization among Black women. DESIGN In this qualitative study, we conducted focus groups with medical providers at three federally qualified health centers in the Southern and Midwestern United States to identify themes informing the development of a provider PrEP training. METHODS Providers were asked for input on content/design of PrEP training. Transcripts underwent rapid qualitative analysis using the Stanford Lightning Report Method. Themes were identified and presented under the domains of the Consolidated Framework for Implementation Research. RESULTS Ten providers completed four focus groups. Themes included the individual characteristics of providers (low comfort initiating PrEP discussions, particularly among White providers) and the outer setting of client attitudes (perceptions of potential provider bias/racism, varying levels of concern about HIV acquisition). Opportunities were identified to maximize the benefit of training design (e.g., developing case scenarios to enhance providers' cultural competency with Black women and PrEP knowledge). CONCLUSION This comprehensive PrEP training features both didactic material and interactive role-plays to equip providers with the clinical knowledge for prescribing PrEP while building their competency discussing PrEP with Black women. This training is particularly important for providers who have racial or gender discordance with Black women and express lower comfort discussing PrEP with these clients. Provider training could lead to minimizing racial- and gender-based inequities in PrEP use.
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Affiliation(s)
- Nikki Kasal
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Samantha Devlin
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Amy K Johnson
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alicia Dawdani
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ososese E Enaholo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Geoffroy Liegeon
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Maria Pyra
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadia Haider
- Division of Family Planning, Rush University, Chicago, IL, USA
| | | | | | - Jessica P Ridgway
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
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Devlin SA, Ridgway JP, Dawdani A, Enaholo OE, Liegeon G, Kasal N, Pyra M, Hirschhorn LR, Simon J, Haider S, Ducheny K, Johnson AK. Adapting Provider Training and Pre-Exposure Prophylaxis Advertising to Increase Pre-Exposure Prophylaxis Awareness and Uptake Among Black Cisgender Women. AIDS Patient Care STDS 2023; 37:574-582. [PMID: 38011350 PMCID: PMC10732154 DOI: 10.1089/apc.2023.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Black cisgender women (hereafter referred to as "women") have disproportionately high rates of HIV infection yet low rates of pre-exposure prophylaxis (PrEP) utilization. Barriers to PrEP uptake exist at the system, provider, and individual/client level. To learn how existing training and advertising can be adapted to address race- and sex-based gaps within PrEP service delivery, we conducted focus groups with providers and Black women. Participants were recruited at three health care organizations in the Midwest and South, screened for eligibility, and consented verbally. Focus groups occurred from August 2022 to February 2023. Women were asked about their knowledge and thoughts on PrEP. Providers were asked about factors influencing their decision-making about PrEP. A codebook was developed based on the Consolidated Framework for Implementation Research. Transcripts were coded using the Stanford Lightning Report Method. We completed four focus groups with 10 providers and 9 focus groups with 25 women. Three major themes emerged: (1) low comfort level and limited cultural sensitivity/competency among providers discussing HIV risk and PrEP with Black women, (2) women's concerns about PrEP's side effects and safety during pregnancy, and (3) lack of Black women representation in PrEP advertisement/educational materials. In addition, women in the South reported general medical mistrust and specific misconceptions about PrEP. PrEP trainings for providers need detailed information about the safety of PrEP for women and should include role-playing to enhance cultural competency. Likewise, PrEP advertisements/materials should incorporate information regarding side effects and images/experiences of Black women to increase PrEP awareness and uptake among this population. Clinical Trial Registration Number: NCT05626452.
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Affiliation(s)
| | | | - Alicia Dawdani
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ososese E. Enaholo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Geoffroy Liegeon
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nikki Kasal
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Maria Pyra
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Sadia Haider
- Division of Family Planning, Rush University, Chicago, Illinois, USA
| | | | - Amy K. Johnson
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Price G, Hubach RD, Currin JM, Owens C. Knowledge, sex, and region associated with primary care providers prescribing adolescents HIV pre-exposure prophylaxis. Sci Rep 2023; 13:16958. [PMID: 37806978 PMCID: PMC10560675 DOI: 10.1038/s41598-023-44165-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/04/2023] [Indexed: 10/10/2023] Open
Abstract
Although HIV pre-exposure prophylaxis (PrEP) effectively and safely prevents HIV among adolescents, uptake of PrEP is low. Adolescents must have primary care providers (PCPs) prescribe them PrEP, making PCPs critical actors in PrEP delivery. However, research has primarily investigated determinants of PCPs' intention to prescribe adolescents PrEP rather than the determinants of performing the behavior itself. We examined the demographic, clinical practice, and implementation determinants of PCPs previously prescribing PrEP to adolescents. PCPs were recruited from a national Qualtrics panel of licensed medical providers in the United States from July 15-August 19, 2022. The Theoretical Domains Framework informed the implementation determinants measured. A multivariable logistic regression was used. PCPs who were more knowledgeable of the CDC guidelines (aOR 2.97, 95% CI 2.16-4.10), who were assigned male at birth (aOR 1.64, 95% CI 1.03-2.59), and who practiced in the Western region (aOR 1.85, 95% CI 1.04-3.30) had greater odds of prior prescribing adolescents PrEP. Provider-based educational interventions should be designed, implemented, and tested to encourage PCPs to prescribe PrEP to eligible adolescents.
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Affiliation(s)
- Garrett Price
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Joseph M Currin
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, CO, USA
| | - Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab Rd., College Station, TX, 77843, USA.
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12
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King HL, Park E, Blanchard H, Alvarez KS, Harms M, Broker P. Implementation of Sexual Health Curriculum Series: Educational Initiative to Increase STI Screening and Treatment in Dallas, Texas. J Community Health 2023; 48:793-797. [PMID: 37119350 PMCID: PMC10147994 DOI: 10.1007/s10900-023-01224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE A new monthly virtual education curriculum on sexual healthcare was launched in 2021. This is an analysis of the pilot education series designed to increase primary care providers' knowledge of sexual health best practices including taking thorough sexual histories, STI screening and treatment, and PrEP prescribing. METHODS A Sexual Health Curriculum Series was developed as part of a quality improvement initiative at a large urban safety-net hospital in Dallas County, Texas. Didactic sessions were administered to primary care providers and staff via a virtual meeting platform once a month from May 2021 to April 2022. RESULTS A total of 52 participants completed the pre-series survey, and 21 participants filled out the final post-series survey. 70% of respondents who completed the post-series survey reported that they learned new information that was incorporated into their practice. The average percentage correct on individual pre-session surveys was 60% compared to 63% on individual post-session surveys (p = 0.03). CONCLUSION Sexual health education is an important tool to help primary care providers adhere to sexual health best practices. There is a need for ongoing implementation of innovative strategies to improve knowledge and adherence to sexual health best practices. A sexual health curriculum may be effective in helping primary providers recognize patients at increased risk and apply evidence-based guidelines to their practices.
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Affiliation(s)
- Helen L King
- UT Southwestern Medical Center, Dallas, TX, USA.
| | - Eunsol Park
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Michael Harms
- Center of Innovation and Value, Parkland Health, Dallas, TX, USA
| | - Paul Broker
- UT Southwestern Medical Center, Dallas, TX, USA
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13
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Labudde EJ, Gillespie S, Wood A, Middlebrooks L, Gooding HC, Morris CR, Camacho-Gonzalez A. HIV in youth prevention in the emergency department initiative: A survey of pediatric emergency medicine providers. Am J Emerg Med 2023; 72:164-169. [PMID: 37536088 DOI: 10.1016/j.ajem.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/28/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The incidence of HIV among adolescents remains high, and adolescents are known to participate in sexual behaviors that increase their risk for HIV, such as unprotected sex and sex with multiple partners. HIV pre-exposure prophylaxis (PrEP) has been shown to be effective at preventing HIV when taken daily and is approved by the FDA for use in adolescents. Efforts to screen patients in adult emergency departments and connect them with PrEP services have been validated. We surveyed pediatric emergency medicine (PEM) providers to determine their knowledge of PrEP, prescribing practices, willingness to prescribe, and barriers to a screening protocol in the pediatric emergency department (PED). METHODS We administered a survey to a multidisciplinary group of PEM providers to measure knowledge, use, willingness, and implementation barriers to PrEP as well as elements needed for a successful referral system. RESULTS A total of 87 responses were included for analysis. While 79.1% of all providers had heard of PrEP, only 14.8% of prescribing providers had ever discussed PrEP with a patient, and none had ever prescribed PrEP. Overall, 76.3% of all providers were knowledgeable about PrEP based on answers to true/false questions, with prescribing providers significantly more likely to be knowledgeable compared to nurses (p = 0.005). Knowledgeable providers had higher willingness scores to refer for PrEP compared to providers who were not knowledgeable. Ninety-two percent of providers felt a PrEP referral process from the PED would be feasible. Creation of an eligibility algorithm and educational materials were the most common efforts providers preferred to make them more likely to refer for PrEP. The most notable barriers perceived by providers included patient noncompliance with therapy (20.9%), acceptance of PrEP discussion among patients and parents (19.8%), and cost of therapy (15.1%). CONCLUSION PEM providers are knowledgeable about PrEP but have little experience with discussing or prescribing PrEP. Their willingness to refer for PrEP and anticipated feasibility of a PrEP referral system is encouraging. These results support the need for future educational efforts among PEM providers and creation of referral systems for PrEP services from the PED.
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Affiliation(s)
- Emily J Labudde
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America.
| | - Scott Gillespie
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Anna Wood
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Lauren Middlebrooks
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Holly C Gooding
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Claudia R Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Division of Infectious Disease, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
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14
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Vora AS, Marroquin M, Rosenthal SL, Broker P, Jetelina K, Tiro JA, Francis JK. Residents and Fellows’ Confidence in Prescribing Pre-exposure Prophylaxis (PrEP). Acad Pediatr 2023; 23:1282-1287. [PMID: 36893907 DOI: 10.1016/j.acap.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Residents and fellows are often the first health.ßcare providers to discuss sexual health and prevention with adolescents and young adults at academic institutions. This study characterized when learners in Pediatrics, Obstetrics and Gynecology, and Family Medicine believed that one should receive training in pre-exposure prophylaxis (PrEP) and it described confidence in prescribing PrEP. METHODS Learners at a large, urban, southern academic center completed an online survey about adolescent sexual health services. Measures included whether participants were taught how to prescribe PrEP and how to do so in a confidential manner. Confidence in these two behaviors was measured with a Likert scale and dichotomized for bivariate analysis. RESULTS Among the 228 respondents (63% response rate), most learners preferred sexual health communication to be emphasized early in medical school and throughout training. Overall, 44% reported being ..únot confident at all..Ñ in prescribing PrEP, and 22% were ..únot confident at all..Ñ in prescribing in a confidential manner. Those who reported ..únot confident at all" in prescribing PrEP were more likely in pediatrics (51%) than family medicine (23%) or obstetrics-gynecology (35%) (P.ß<.ß.01). Those who had been taught how to prescribe were more confident in prescribing PrEP (P.ß..±.ß.01) and prescribing in a confidential manner (P.ß<.ß.01). CONCLUSIONS Given the continued high rates of new human immunodeficiency virus infections among adolescents, effective communication with patients eligible for PrEP is critical. Future studies should evaluate and inform tailored curricula about the importance of PrEP and build communication skills around confidential prescribing.
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Affiliation(s)
- Anjali S Vora
- Division of Internal Medicine and Pediatrics (AS Vora and P Broker), University of Texas Southwestern Medical Center, Dallas.
| | - Monica Marroquin
- Department of Population and Data Sciences (M Marroquin, K Jetelina, and JA Tiro), University of Texas Southwestern Medical Center, Dallas
| | - Susan L Rosenthal
- Departments of Pediatrics and Psychiatry (SL Rosenthal), Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Paul Broker
- Division of Internal Medicine and Pediatrics (AS Vora and P Broker), University of Texas Southwestern Medical Center, Dallas
| | - Katelyn Jetelina
- Department of Population and Data Sciences (M Marroquin, K Jetelina, and JA Tiro), University of Texas Southwestern Medical Center, Dallas; Department of Epidemiology (K Jetelina), Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX
| | - Jasmin A Tiro
- Department of Population and Data Sciences (M Marroquin, K Jetelina, and JA Tiro), University of Texas Southwestern Medical Center, Dallas
| | - Jenny Kr Francis
- Department of Pediatrics (JKR Francis), University of Texas Southwestern Medical Center, Children's Health, Dallas, Texas
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15
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Hoffman S, Jamison K, Pathela P, Gonzalez-Argoti T, Rivera A, Leu CS, Hubbard S, Castro M, Borges C, Gandhi A, Edelstein Z, Myers J, Mantell JE, Bauman LJ. Health Care Provider Decisions to Initiate Oral HIV Preexposure Prophylaxis in New York City Public Sexual Health Clinics. Sex Transm Dis 2023; 50:386-394. [PMID: 36749905 PMCID: PMC10838661 DOI: 10.1097/olq.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Oral HIV preexposure prophylaxis (PrEP) is safe and effective but underutilized. Health care providers' beliefs about PrEP and attitudes toward people who could benefit may affect PrEP access. METHODS This mixed-methods study (2016-2018) was conducted in 8 New York City public sexual health clinics that implemented a PrEP program. Data included 32 in-depth qualitative interviews with clinicians, quantitatively coded to reflect their PrEP beliefs; a provider questionnaire; and 6 months of medical record visit data for these providers. Among patients with a PrEP indication, we examined the odds of a patient being initiated on PrEP associated with providers' PrEP beliefs and demographic characteristics, and patient characteristics. RESULTS Providers reported strong support for offering PrEP to eligible patients. The majority denied concerns about possible development of drug-resistant viral strains, giving PrEP to people who might not benefit, and PrEP toxicity. Nevertheless, about one-third agreed with each of these concerns, and 55% thought PrEP use might limit condom use. Of 2176 patients with a PrEP indication, 20% were initiated. Providers with more restrictive PrEP beliefs did not have lower odds of initiating patients on PrEP. Women as well as Black and Latinx patients were less likely to be initiated on PrEP. CONCLUSIONS Contrary to our hypotheses, providers' negative PrEP beliefs did not seem to reduce initiation of PrEP for eligible patients. This may be attributable to clear clinical protocols, strong staff support, and training on implementing PrEP in this setting. Racial and gender disparities in PrEP uptake urgently require attention.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, NYS
Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
10032
- Department of Epidemiology, Columbia University Mailman
School of Public Health, New York, NY 10032
| | - Kelly Jamison
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Preeti Pathela
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | | | - Angelic Rivera
- Albert Einstein College of Medicine, Department of
Pediatrics Bronx, NY, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University Mailman
School of Public Health, New York, NY 10032
| | - Stephanie Hubbard
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Michael Castro
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Christine Borges
- Bureau of Sexually Transmitted Infections, New York City
Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Anisha Gandhi
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Zoe Edelstein
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Julie Myers
- Bureau of HIV, New York City Department of Health and
Mental Hygiene, Long Island City, NY, USA
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, NYS
Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
10032
| | - Laurie J. Bauman
- Albert Einstein College of Medicine, Department of
Pediatrics Bronx, NY, USA
- Albert Einstein College of Medicine; Department of
Psychiatry and Behavioral Sciences, Bronx NY, USA
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16
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Valente PK, Rusley JC, Operario D, Biello KB. Readiness to Provide Oral and Injectable PrEP for Sexual and Gender Minority Youth Among Healthcare Providers and Clinics in the U.S. Northeast. J Adolesc Health 2023; 72:722-729. [PMID: 36604205 PMCID: PMC10121770 DOI: 10.1016/j.jadohealth.2022.11.246] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/19/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To examine readiness to provide oral and injectable pre-exposure prophylaxis (PrEP) for sexual and gender minority youth (SGMY) and to explore decision-making for HIV prevention strategies (e.g., condom use, daily and event-driven oral PrEP, and injectable PrEP) among healthcare providers. METHODS Between February and April 2022, we recruited 31 prescribing providers (M.Ds, D.Os, P.As, and N.Ps) practicing in primary care and specialized clinics in the U.S. Northeast for focus groups or individual interviews. Focus groups and interview transcripts were analyzed using thematic analysis. RESULTS Most providers specialized in Pediatrics (42%) or Adolescent Medicine (23%) and 58% had previously prescribed PrEP. Main barriers to PrEP readiness were low PrEP knowledge, limited time for visits, and competing clinical priorities. Organizational factors such as routine HIV/STI testing, PrEP-specific electronic health records templates, and specialized staff (e.g., PrEP navigators) promoted PrEP readiness. Providers held positive attitudes toward injectable PrEP to promote adherence among SGMY, yet barriers to implementation of this modality were identified (e.g., patient anxiety about needles, additional staffing needs). Providers described event-driven oral PrEP as an option for SGMY with episodic HIV risk. Assurances of conditional confidentiality, including preventing disclosure of sensitive information through insurance forms, and shared decision-making facilitated conversations about HIV prevention with SGMY. DISCUSSION Future PrEP implementation efforts for SGMY should consider combined efforts targeting provider knowledge about PrEP modalities (e.g., decision aids) and clinic organizational factors (e.g., routine HIV/STI testing, resources to assist providers and patients in navigating the multiple steps between prescription and adherence to PrEP).
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Department of Allied Health Sciences, University of Connecticut, Waterbury, Connecticut.
| | - Jack C Rusley
- Division of Adolescent Medicine, Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; The Fenway Institute, Fenway Health, Boston, Massachusetts
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17
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Kamakura M, Fukuda D, Kuroishi N, Ainiwaer D, Hattori J. Exploring Current Practice, Knowledge, and Challenges of Sexually Transmitted Infection/HIV Management and Pre-Exposure Prophylaxis Among Japanese Health Care Professionals: A Cross-Sectional Web Survey. AIDS Patient Care STDS 2023; 37:253-267. [PMID: 37083443 DOI: 10.1089/apc.2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
We conducted a web-based survey targeting physicians in specialties of treating sexually transmitted infection (STI) and/or human immunodeficiency virus (HIV) patients to understand the current STI/HIV care practices and their acceptability of and barriers to the prescription of pre-exposure prophylaxis (PrEP) in Japan. A descriptive analysis was used to summarize survey responses. Univariate and multivariable logistic regression were performed to identify factors associated with willingness to prescribe PrEP. Of 316 survey respondents, 57 were specialized in HIV, 90 STI/Urology/Proctology, 55 Obstetrics/Gynecology, and 114 General Practice/Internal Medicine/Dermatology. Proportion of HIV-specialized physicians who interview the patients about risk behaviors tended to be higher than other physician groups (84.2% vs. 54.8%, 47.3%, and 50.9%, respectively), and 53 - 75% of non-HIV-specialized physicians reported that they were incapable of making decisions on HIV medications. Higher PrEP knowledge enhanced the willingness to recommend and prescribe PrEP drugs (odds ratio: 2.31, 95% confidence interval: 1.30-4.10, p = 0.0044), and 45.4% physicians with no PrEP knowledge raised the concern of incapability to respond and manage when an individual is infected with HIV. Educational opportunities on management and prevention measures for both STI and HIV may encourage non-HIV-specialized physicians to be involved in HIV care and to enhance initiation of HIV tests and adoption of PrEP.
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18
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Isehunwa OO, Hill SV, Menninger AT, Hubner B, Krakower D, Long DM, Pratt MC, Clement ME, Wagoner NV, Lanzi RG, Simpson T, Elopre L, Matthews LT. A Multicomponent Intervention to Train and Support Family Medicine Providers to Promote Pre-exposure Prophylaxis (PrEP) for Adolescent Girls and Young Women in the Deep South: Protocol for the PrEP-Pro Study. JMIR Res Protoc 2023; 12:e44908. [PMID: 36943364 PMCID: PMC10131664 DOI: 10.2196/44908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps. OBJECTIVE This paper describes the "PrEP-Pro" intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama. METHODS The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months. RESULTS Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals. CONCLUSIONS As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44908.
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Affiliation(s)
- Oluwaseyi O Isehunwa
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Samantha V Hill
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alex Tobias Menninger
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Brook Hubner
- Department of Medical Education, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Douglas Krakower
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Dustin M Long
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Madeline C Pratt
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Meredith E Clement
- Section of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Nicholas Van Wagoner
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robin Gaines Lanzi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tina Simpson
- Tulane University School of Medicine, New Orleans, LA, United States
| | - Latesha Elopre
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lynn T Matthews
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Owens C, Hubach RD. Rural-urban differences in monkeypox behaviors and attitudes among men who have sex with men in the United States. J Rural Health 2023; 39:508-515. [PMID: 36394371 DOI: 10.1111/jrh.12726] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE An outbreak of the monkeypox virus has been documented in the United States with most cases occurring among gay, bisexual, and other men who have sex with men (MSM). As monkeypox cases increase among relatively rural states, current public health messaging may not resonate with rural at-risk populations. Given this, there is a need to assess potential rural-urban differences in monkeypox behaviors and attitudes among MSM. METHODS A total of 582 eligible MSM completed an online cross-sectional survey between August 6 and 15, 2022. Participants answered questions about their demographics, sexual behaviors, monkeypox testing and vaccination behaviors, monkeypox media consumption and attitudes, and their intention and attitudes found in the Health Belief Model of getting the monkeypox vaccine. Rural-urban differences in behaviors and attitudes were assessed with a chi-square test of independence. Differences in intention to get vaccinated and Health Belief Model factors were assessed with a Mann-Whitney U test. FINDINGS Rural MSM, in comparison to their urban counterparts, were found to be less likely to report modifying their behaviors to decrease monkeypox exposure, being susceptible to monkeypox, or perceiving severe consequences acquiring monkeypox. Similarly, rural MSM had a lower intention to get vaccinated for monkeypox. CONCLUSIONS As vaccination uptake among rural populations for vaccine-preventable diseases remains suboptimal, results from this novel study can inform the development of monkeypox prevention, testing, and vaccination messaging campaigns geared toward rural MSM and other at-risk populations. It will be important to ensure that monkeypox prevention, testing, and vaccination interventions are available and accessible in rural areas.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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20
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Saberi P, Mehtani NJ, Sayegh A, Camp CE, Chu C. Understanding HIV Pre-Exposure Prophylaxis Questions of U.S. Health Care Providers: Unique Perspectives from the PrEPline Clinical Teleconsultation Service. Telemed J E Health 2023; 29:376-383. [PMID: 35802493 PMCID: PMC10024264 DOI: 10.1089/tmj.2022.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Fewer than a quarter of people considered to have factors associated with HIV acquisition are prescribed pre-exposure prophylaxis (PrEP) in the United States. Prior studies demonstrate disparities in provider comfort and knowledge regarding PrEP, suggesting a need for provider capacity building to support widespread PrEP availability. This study examined real-world PrEP clinical questions/cases from providers to a teleconsultation service to identify knowledge gaps and improve PrEP-related training materials and clinical guidelines. Methods: The National Clinician Consultation Center (NCCC) PrEPline provides educational teleconsultation services on clinical decision-making related to PrEP for U.S. health care providers. The NCCC PrEP consultation data collected between 2017 and 2020 were reviewed and systematically categorized by clinical topics, subtopics, and complexity levels (low, moderate, and high). Results: Within the study period, the PrEPline provided 1,754 teleconsultations. More than three quarters came from advanced practice nurses and physicians. The topics of questions commonly focused on medication-based HIV prevention strategies (22.7%), PrEP laboratory ordering/monitoring (17.4%), and side effects and contraindications (14.6%). The majority of teleconsultations (57.9%) involved sharing information that was directly available/addressed in the Centers for Disease Control and Prevention (CDC) 2017 PrEP Guidelines (i.e., low complexity). Discussion: The low frequency of consultations from nonphysician and non-nurse practitioner providers may suggest a need for increased training and collaborative opportunities for other types of providers. The high percentage of low-complexity inquiries may reveal a desire for capacity-building materials specifically designed for practicing providers (e.g., abridged versions of guidelines). This study may inform future research, best clinical practices, and aid in the development of training materials to increase providers' HIV prevention comfort and knowledge.
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Affiliation(s)
- Parya Saberi
- Department of Medicine and University of California, San Francisco, San Francisco, California, USA
| | - Nicky J. Mehtani
- Department of Medicine and University of California, San Francisco, San Francisco, California, USA
| | - Anthony Sayegh
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christina Elizabeth Camp
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Carolyn Chu
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
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Ogundare MO, Allan F, Desai AP, Dirajlal-Fargo S, Minich NM, Gripshover BM. Integrating HIV Pre-Exposure Prophylaxis (PrEP) Education During Medical Residency: Training Outcomes and Suggestions for Learning Effectiveness. J Prim Care Community Health 2023; 14:21501319231207313. [PMID: 37933559 PMCID: PMC10631327 DOI: 10.1177/21501319231207313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is now preventable with pre-exposure prophylaxis (PrEP) drugs, however, barriers to PrEP implementation include primary-care physician (PCP) knowledge-gap and lack of comfort prescribing and managing PrEP. We hypothesized that integrating HIV-PrEP education during medical-residency would help address these problems and developed a 40-minute case-based lecture focused on the 2021 United States Preventative Services Taskforce (USPSTF) oral HIV-PrEP guidelines and integrated this into our residency's core curriculum. We analyzed data from physician-trainees who voluntarily completed a pre- and post-lecture survey measuring HIV-PrEP "knowledge" and "self-assessed readiness to independently initiate and manage PrEP." Independent group analysis was completed via the Mann-Whitney U and Pearson Chi-square 2-sided test with P-value <0.05 deemed significant. Of the total of 189 residents invited to the lecture, 130 (69%) completed the pre-survey while 107 (57%) completed the post-survey. Per knowledge-assessment: the median number of correctly answered questions rose from a pre-lecture baseline of 4/9 (44%) to 8/9 (89%) following the education intervention (P < .001). When asked about comfort initiating and managing HIV-PrEP on their own, 7/130 (5.4%) responded in agreement pre-lecture, but this rose to 55/107 (51.4%) post-lecture (P < .001). Our study revealed PrEP training during residency was effective per stated objectives and may be an important tool to increase PrEP delivery/uptake to achieve the target goals for the National HIV/AIDS Strategy.
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Affiliation(s)
- Matilda Olajumoke Ogundare
- Department of Pediatrics, University Hospitals Cleveland Medical Center/Rainbow Babies and Children’s Hospital, Cleveland, Ohio
- Case Western Reserve University, Cleveland, OH, USA
| | - Fiona Allan
- Case Western Reserve University, Cleveland, OH, USA
- John T. Carey Special Immunology Unit, Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ankita P. Desai
- Department of Pediatrics, University Hospitals Cleveland Medical Center/Rainbow Babies and Children’s Hospital, Cleveland, Ohio
- Case Western Reserve University, Cleveland, OH, USA
| | - Sahera Dirajlal-Fargo
- Department of Pediatrics, University Hospitals Cleveland Medical Center/Rainbow Babies and Children’s Hospital, Cleveland, Ohio
- Case Western Reserve University, Cleveland, OH, USA
| | - Nori Mercuri Minich
- Department of Pediatrics, University Hospitals Cleveland Medical Center/Rainbow Babies and Children’s Hospital, Cleveland, Ohio
- Case Western Reserve University, Cleveland, OH, USA
| | - Barbara M. Gripshover
- Case Western Reserve University, Cleveland, OH, USA
- John T. Carey Special Immunology Unit, Division of Infectious Diseases and HIV Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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22
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Provision of HIV preexposure prophylaxis to female patients seeking family planning services in the United States. AIDS 2023; 37:137-148. [PMID: 36172845 DOI: 10.1097/qad.0000000000003398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We conducted a scoping review to assess barriers to and facilitators of integrating HIV preexposure prophylaxis (PrEP) and family planning (FP) at the patient, provider, and implementation levels, and to identify gaps in knowledge. METHODS We conducted a search of five bibliographic databases from database inception to March 2022: PubMed, CINAHL, Embase, Web of Science and Scopus. Two reviewers screened abstracts and full texts to determine eligibility based on a priori inclusion and exclusion criteria. We categorized studies by their relevance to patient, provider, and implementation barriers, and extracted data based on prespecified elements. RESULTS Our initial search strategy yielded 1151 results, and 34 publications were included. Barriers to PrEP implementation in family planning settings included low PrEP knowledge among patients, hesitance to take PrEP due to perceived stigma, decreased willingness of providers unfamiliar with PrEP to prescribe PrEP, and limited financial and staffing resources that make prescribing and monitoring PrEP difficult. Facilitators included robust training for providers, stigma reduction efforts, leadership engagement, and increased resources specifically in settings with processes in place that ease the process of prescribing and monitoring PrEP. CONCLUSIONS Advances in implementation strategy development, stigma reduction, and drug development will be essential to reinforcing PrEP care in family planning settings and thereby reducing the incidence of HIV in women through highly effective pharmacologic HIV prevention methods.
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Nacht CL, Felner JK, Muthuramalingam S, Towner W, Ling Grant D, Martos A, Chang JM, Hechter R, Storholm ED. Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care. JOURNAL OF CLINICAL RESEARCH IN HIV AIDS AND PREVENTION 2022; 4:15-31. [PMID: 37841674 PMCID: PMC10572105 DOI: 10.14302/issn.2324-7339.jcrhap-22-4371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, only around 25% of at-risk individuals in the United States have accessed a prescription. One way to increase PrEP uptake is through the sexual health screening of patients and linkage to PrEP in primary care settings. The objective of this analysis was to assess the barriers and implementation strategies during a screening and linkage to PrEP pilot intervention. Primary care patients were screened for PrEP indication during routine primary care visits. Of the 1,225 individuals screened, 1.8% (n=22) were eligible for PrEP and from those, 77.3% (n=17) attended the specialist appointment and were prescribed PrEP. Primary care patients (n=30) and providers (n=8) then participated in semi-structured interviews assessing their experience with the pilot intervention. Using an applied thematic analytic approach, patients and providers identified barriers and related improvement strategies that could be classified into four main categories: 1) Financial Barriers: Individual- vs. Clinic-level Considerations 2) The Role of Stigma, Discomfort, and Cultural Factors 3) Logistical Hurdles and Streamlining the Intervention, and 4) The Lack of PrEP Knowledge and the Need for Education. Findings support the accepatability and feasibility of screening for PrEP in primary care along with appropriate implementation strategies. This study suggests that because of the high volume of patients seen in primary care, sexual health screenings and linkage to PrEP interventions have the potential to reduce new incident HIV infections among diverse sexual minority men.
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Affiliation(s)
- Carrie L Nacht
- San Diego State University, School of Public Health, San Diego, CA
| | - Jennifer K Felner
- San Diego State University, School of Public Health, San Diego, CA
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, CA
| | | | - William Towner
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Deborah Ling Grant
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Alexander Martos
- Southern California Permanente Medical Group, Los Angeles Medical Center Department of Consulting Services, Los Angeles, CA
| | - John M Chang
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Rulin Hechter
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Erik D Storholm
- San Diego State University, School of Public Health, San Diego, CA
- RAND Corporation, Behavioral and Policy Sciences, Santa Monica, CA
- University of California Los Angeles, Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA
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24
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Chan CT, Carlson J, Lee T, Vo M, Nasr A, Hart-Cooper G. Usability and Utility of Human Immunodeficiency Virus Pre-exposure Prophylaxis Clinical Decision Support to Increase Knowledge and Pre-exposure Prophylaxis Initiations among Pediatric Providers. Appl Clin Inform 2022; 13:1141-1150. [PMID: 36351546 PMCID: PMC9731791 DOI: 10.1055/a-1975-4277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES An effective clinical decision support system (CDSS) may address the current provider training barrier to offering preexposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV) infection. This study evaluated change in provider knowledge and the likelihood to initiate PrEP after exposure to a PrEP CDSS. A secondary objective explored perceived provider utility of the CDSS and suggestions for improving CDSS effectiveness. METHODS This was a prospective study using survey responses from a convenience sample of pediatric providers who launched the interruptive PrEP CDSS when ordering an HIV test. McNemar's test evaluated change in provider PrEP knowledge and likelihood to initiate PrEP. Qualitative responses on CDSS utility and suggested improvements were analyzed using framework analysis and were connected to quantitative analysis elements using the merge approach. RESULTS Of the 73 invited providers, 43 had available outcome data and were included in the analysis. Prior to using the CDSS, 86% of participants had never been prescribed PrEP. Compared to before CDSS exposure, there were significant increases in the proportion of providers who were knowledgeable about PrEP (p = 0.0001), likely to prescribe PrEP (p < 0.0001) and likely to refer their patient for PrEP (p < 0.0001). Suggestions for improving the CDSS included alternative "triggers" for the CDSS earlier in visit workflows, having a noninterruptive CDSS, additional provider educational materials, access to patient-facing PrEP materials, and additional CDSS support for adolescent confidentiality and navigating financial implications of PrEP. CONCLUSION Our findings suggest that an interruptive PrEP CDSS attached to HIV test orders can be an effective tool to increase knowledge and likelihood to initiate PrEP among pediatric providers. Continual improvement of the PrEP CDSS based on provider feedback is required to optimize usability, effectiveness, and adoption. A highly usable PrEP CDSS may be a powerful tool to close the gap in youth PrEP access and uptake.
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Affiliation(s)
- Carrie T. Chan
- Lucile Packard Children's Hospital, Palo Alto, California, United States,Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, United States,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States,Address for correspondence Carrie Chan, MSN, MPH, CPNP Stanford Children's Health750 Welch Road, Suite 212, Palo Alto, CA 94304United States
| | - Jennifer Carlson
- Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California United States
| | - Tzielan Lee
- Department of Pediatrics—Rheumatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Megen Vo
- Department of Pediatrics—Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California United States
| | - Annette Nasr
- Lucile Packard Children's Hospital, Palo Alto, California, United States,Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, United States,Department of Pediatrics-Gastroenterology, Stanford University School of Medicine, Palo Alto, California United States
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25
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Ramakrishnan A, Sales JM, McCumber M, Powell L, Sheth AN. Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training. Open Forum Infect Dis 2022; 9:ofac536. [PMID: 36349276 PMCID: PMC9636854 DOI: 10.1093/ofid/ofac536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective human immunodeficiency virus (HIV) prevention intervention, but its access and use are suboptimal, especially for women. Healthcare providers provision of PrEP is a key component of the Ending the HIV Epidemic initiative. Although training gaps are an identified barrier, evidence is lacking regarding how to tailor trainings for successful implementation. Title X family planning clinics deliver safety net care for women and are potential PrEP delivery sites. To inform provider training, we assessed PrEP knowledge, attitudes, and self-efficacy in the steps of PrEP care among Title X providers in the Southern United States. Methods We used data from providers in clinics that did not currently provide PrEP from a web-based survey administered to Title X clinic staff in 18 Southern states from February to June 2018. We developed generalized linear mixed models to evaluate associations between provider-, clinic-, and county-level variables with provider knowledge, attitudes, and self-efficacy in PrEP care, guided by the Consolidated Framework for Implementation Research. Results Among 351 providers from 193 clinics, 194 (55%) were nonprescribing and 157 (45%) were prescribing providers. Provider ability to prescribe medications was significantly associated PrEP knowledge, attitudes, and self-efficacy. Self-efficacy was lowest in the PrEP initiation step of PrEP care and was positively associated with PrEP attitudes, PrEP knowledge, and contraception self-efficacy. Conclusions Our findings suggest that PrEP training gaps for family planning providers may be bridged by addressing unfavorable PrEP attitudes, integrating PrEP and contraception training, tailoring training by prescribing ability, and focusing on the initiation steps of PrEP care.
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Affiliation(s)
- Aditi Ramakrishnan
- Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA
| | - Jessica M Sales
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Micah McCumber
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA
| | - Leah Powell
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia , USA
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26
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Saberi P, Stoner MCD, Ming K, Lisha NE, Hojilla JC, Scott HM, Liu AY, Steward WT, Johnson MO, Neilands TB. The effect of an HIV preexposure prophylaxis panel management strategy to increase preexposure prophylaxis prescriptions. AIDS 2022; 36:1783-1789. [PMID: 35730363 PMCID: PMC9529898 DOI: 10.1097/qad.0000000000003283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The HIV preexposure prophylaxis optimization intervention (PrEP-OI) study evaluated the efficacy of a panel management intervention using PrEP coordinators and a web-based panel management tool to support healthcare providers in optimizing PrEP prescription and ongoing PrEP care. DESIGN The PrEP-OI study was a stepped-wedge randomized clinical trial conducted across 10 San Francisco Department of Public Health primary care sites between November 2018 and September 2019. Each month, clinics one-by-one initiated PrEP-OI in random order until all sites received the intervention by the study team. METHODS The primary outcome was the number of PrEP prescriptions per month. Secondary outcomes compared pre- and postintervention periods on whether PrEP was discussed and whether PrEP-related counseling (e.g., HIV risk assessment, risk reduction counseling, PrEP initiation/continuation assessment) was conducted. Prescription and clinical data were abstracted from the electronic health records. We calculated incidence rate ratios (IRR) and risk ratios (RR) to estimate the intervention effect on primary and secondary outcomes. RESULTS The number of PrEP prescriptions across clinics increased from 1.85/month (standard deviation [SD] = 2.55) preintervention to 2.44/month (SD = 3.44) postintervention (IRR = 1.34; 95% confidence interval [CI] = 1.05-1.73; P = 0.021). PrEP-related discussions during clinic visits (RR = 1.13; 95% CI = 1.04-1.22; P = 0.004), HIV risk assessment (RR = 1.40; 95% CI = 1.14-1.72; P = 0.001), and risk reduction counseling (RR = 1.16; 95% CI = 1.03-1.30; P = 0.011) increased from the pre- to the postintervention period. Assessment of PrEP initiation/continuation increased over time during the postintervention period (RR = 1.05; 95% CI = 0.99-1.11; P = 0.100). CONCLUSIONS A panel management intervention using PrEP coordinators and a web-based panel management tool increased PrEP prescribing and improved PrEP-related counseling in safety-net primary care clinics.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, University of California, San Francisco, San Francisco
| | | | - Kristin Ming
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Nadra E Lisha
- Center for Tobacco Control Research and Education; University of California, San Francisco
| | - J Carlo Hojilla
- Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California
| | - Hyman M Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California,, USA
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California,, USA
| | - Wayne T Steward
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco
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27
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Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, Mayer KH, Biello KB. Next Generation Pre-Exposure Prophylaxis for Young Men who have Sex with Men: Lessons from System and Provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-3435. [PMID: 35445994 PMCID: PMC9474568 DOI: 10.1007/s10461-022-03665-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
Next generation pre-exposure prophylaxis (PrEP) modalities that do not require daily regimens may address some of the barriers to daily oral PrEP among young men who have sex with men (YMSM). We conducted online semi-structured interviews with 30 YMSM to examine experiences and preferences related to HIV prevention care that may inform implementation of next generation PrEP. Barriers to PrEP care included initiating conversations about sexuality with providers; confidentiality concerns regarding disclosure of sexual practices and PrEP use to family; gaps in access to healthcare; and limited availability of affordable health services. Future implementation of next generation PrEP may benefit from providers addressing confidentiality concerns when discussing PrEP with YMSM; PrEP programs accounting for discontinuities in healthcare access among YMSM while strengthening access to affordable services; and collaborations between generalist providers and specialized clinics and providers to address providers' education needs, which may increase as next generation PrEP becomes available. We have linked affiliation 9 to author name "Katie B. Biello". Please check and confirm. Okay!
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S
| | - Jose A Bauermeister
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, U.S
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, U.S
| | - Willey Y Lin
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, U.S
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S
| | - Jack Rusley
- Division of Adolescent Medicine, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, U.S
- Department of Health Services, Policy, and Practice, Brown University School of Public, Providence, RI, U.S
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, U.S
| | | | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S..
- The Fenway Institute, Fenway Health, Boston, MA, U.S..
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, U.S..
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, U.S..
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28
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Zapata JP, de St Aubin E, Rodriguez-Diaz CE, Malave-Rivera S. Using a Structural-Ecological Model to Facilitate Adoption of Preexposure Prophylaxis Among Latinx Sexual Minority Men: A Systematic Literature Review. JOURNAL OF LATINX PSYCHOLOGY 2022; 10:169-190. [PMID: 37456610 PMCID: PMC10348365 DOI: 10.1037/lat0000204] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Research has consistently shown that individual, interpersonal, community and structural factors influence the degree to which individuals' access and utilize health care services, and these factors may play a role in explaining racial and ethnic differences in health care outcomes. Differences in HIV prevalence and treatment between Latinx adults and white adults in the U.S. must be considered in the context of these factors. However, much of the existing research connecting these factors and HIV/AIDS outcomes in Latinxs remains disparate, limited in scope, and has yet not been applied to the use of biomedical HIV preventions. The following systematic literature review examined research related to PrEP in Latinx sexual minority men (SMM) to build a structural-ecological framework of the existing research, while identifying gaps in the literature and areas for future research. We searched two electronic databases using a systematic review protocol, screened 71 unique records, and identified 23 articles analyzing data from Latinx SMM and intended and/or actual PrEP-use in the United States. Based on the present review, disparities in PrEP uptake by Latinx SMM could be explained, in part, by examining how all levels of the structural-ecological framework uniquely contributes to how Latinx SMM engage with HIV prevention measures and come to understand PrEP. It is clear from the existing literature base that some of the most prominent barriers deterring Latinx SMM from seeking PrEP services are the lack of information surrounding PrEP and HIV/gay stigmas. However, higher order structural-level risks can facilitate or reduce access to PrEP. We propose a structural-ecological model to help visualize multi-level domains of unique stressors that limit the implementation of PrEP among Latinxs. At this stage, the available literature provides little guidance beyond suggesting that culturally adapted interventions can be effective in this population. The model developed here provides that needed specificity regarding targeted interventions that will fit the needs of this population.
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Affiliation(s)
| | - Ed de St Aubin
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Carlos E Rodriguez-Diaz
- Department of Prevention and Community Health, The George Washington UniversityMilken, Institute School of Public Health
| | - Souhail Malave-Rivera
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico Medical sciences Campus
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29
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Falconi‐McCahill A, Lee ASD, Knights JE. Evaluation of a pre‐exposure prophylaxis (PrEP) program for HIV prevention in a federally qualified health center (FQHC). Worldviews Evid Based Nurs 2022; 19:219-226. [DOI: 10.1111/wvn.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/19/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Amy S. D. Lee
- Capstone College of Nursing The University of Alabama Tuscaloosa Alabama USA
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30
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Martinez-Cajas JL, Torres J, Mueses HF, Plazas PC, Arrivillaga M, Gomez SA, Galindo X, Buitrago EM, Llano BEA. Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study. Implement Sci Commun 2022; 3:31. [PMID: 35296369 PMCID: PMC8925047 DOI: 10.1186/s43058-022-00278-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP. Methods We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks’ domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation. Results We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care. Conclusion Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00278-2.
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Affiliation(s)
- Jorge Luis Martinez-Cajas
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, K7L 3 N6, Canada
| | - Julian Torres
- Montefiore Medical Center, Moses Division, Albert Einstein College of Medicine, The Oval Center at Montefiore, 3230 Bainbridge Ave, Bronx, NY, 10467, USA
| | | | | | - Marcela Arrivillaga
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Sheila Andrea Gomez
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Ximena Galindo
- Corporación de Lucha Contra el Sida, Carrera 56 2- 120, Cali, Colombia
| | - Ernesto Martinez Buitrago
- Departamento de Medicina Interna, Universidad del Valle, Calle 5 36-08 Hospital Universitario del Valle, Cali, Colombia
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31
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Irungu EM, Musau M, Nyerere B, Dollah A, Kwach B, Owidi E, Wamoni E, Odoyo J, Mugo N, Bukusi E, Mugwanya K, Baeten JM. Using an on-site modular training approach to amplify prep service delivery in public health facilities in Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000092. [PMID: 36962311 PMCID: PMC10021257 DOI: 10.1371/journal.pgph.0000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022]
Abstract
Delivery of oral PrEP, a potent HIV prevention intervention, has begun within public health systems in many countries in Africa. Training as many health providers as possible expeditiously is necessary to efficiently and rapidly scale up PrEP delivery among at risk populations and thereby realize the greatest impact of PrEP. We designed and implemented an innovative on-site modular training approach delivered in five two-hour modules. The modules could be covered in two consecutive days or be broken across several days enabling flexibility to accommodate health provider work schedules. We assessed knowledge gain comparing pre-and post-training test scores and determined monthly PrEP uptake for six months following the training intervention. We also evaluated the cost of this training approach and conducted key informant interviews to explore acceptability among health providers. Between January 2019 and December 2020, 2111 health providers from 104 health facilities were trained on PrEP. Of 1821 (83%) providers who completed both pre- and post-tests, 505 (28%) were nurses, 333 (18%) were HIV counsellors, 276 (15%) were clinical officers and 255 (14%) were lay providers. The mean score prior to and after training was 58% and 82% respectively (p <0.001). On average, health facilities initiated an average of 2.7 (SD 4.7) people on PrEP each month after the training, a number that did not decline over six months post-training (p = 0.62). Assuming Ministry of Health costs, the costs per provider trained was $16.27. Health providers expressed satisfaction with this training approach because it enabled many providers within a facility receive training. On-site modular training is an effective approach for improving PrEP education for health workers in public health facilities, It is also acceptable and low-cost. This method of training can be scaled up to rapidly amplify the number of health workers able to offer PrEP services.
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Affiliation(s)
- Elizabeth M Irungu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Moses Musau
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Bernard Nyerere
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anabelle Dollah
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Benn Kwach
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmah Owidi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Wamoni
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Josephine Odoyo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nelly Mugo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Epidemiology, University of Washington, Seattle, WA, United States of America
- Medicine, University of Washington, Seattle, WA, United States of America
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Geldsetzer P, Chebet JJ, Tarumbiswa T, Phate-Lesihla R, Maponga C, Mandara E, Bärnighausen T, McMahon SA. Knowledge and attitudes about HIV pre-exposure prophylaxis: Evidence from in-depth interviews and focus group discussions with policy makers, healthcare providers, and end-users in Lesotho. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000762. [PMID: 36962565 PMCID: PMC10021845 DOI: 10.1371/journal.pgph.0000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/24/2022] [Indexed: 03/26/2023]
Abstract
Studies on knowledge and attitudes about HIV pre-exposure prophylaxis (PrEP) have mostly focused on key populations in North America and Europe. To inform Lesotho's national rollout of PrEP to the general population, this study aimed to characterize knowledge and attitudes about PrEP among policy makers, implementing partners, healthcare providers, and PrEP end-users in Lesotho. Respondents were purposively selected to participate based on personal experience in the development and implementation of Lesotho's PrEP program, or the personal use of PrEP. We conducted 106 in-depth interviews with policy makers (n = 5), implementing partners (n = 4), and end-users (current PrEP users = 55; former PrEP users = 36; and PrEP "decliners" = 6). In addition, we held 11 focus group discussions (FGDs) with a total of 105 healthcare providers. Interview and FGD transcripts were analyzed following the tenets of Grounded Theory. Respondents expressed positive attitudes toward PrEP, owing to experienced and perceived personal, familial, and societal benefits. PrEP was viewed as i) an opportunity for serodiscordant couples to remain together, ii) a means of conceiving children with minimized risk of HIV infection, iii) providing a sense of agency and control, and iv) an avenue for addressing the HIV epidemic in Lesotho. Respondents demonstrated understanding of PrEP's intended use, eligibility requirements, and modality of use. However, respondents also reported that several important misconceptions of PrEP were common among adults in Lesotho, including a belief that PrEP protects against sexually transmitted infections other than HIV, promotes promiscuity, prevents pregnancy, causes seroconversion, and provides lifelong protection from taking the pill just once. In addition to building on the perceived advantages of PrEP to shape a positive message, Lesotho's national rollout of PrEP will likely benefit from a communication strategy that specifically addresses the common misconceptions of PrEP identified in this study.
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Affiliation(s)
- Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Joy J Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Tapiwa Tarumbiswa
- Disease Control Department, Lesotho Ministry of Health, Maseru, Lesotho
| | | | - Chivimbiso Maponga
- Clinton Health Access Initiative-Lesotho Country Office, Maseru, Lesotho
| | - Esther Mandara
- Clinton Health Access Initiative-Lesotho Country Office, Maseru, Lesotho
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Willie TC, Sharpless L, Monger M, Kershaw TS, Mahoney WB, Stockman JK. Enhancing domestic violence advocates' ability to discuss HIV pre-exposure prophylaxis (PrEP): Feasibility and acceptability of an educational intervention. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065211070548. [PMID: 35001751 PMCID: PMC8744168 DOI: 10.1177/17455065211070548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Survivors of intimate partner violence are at elevated risk for HIV acquisition, yet there is limited research on the best strategies to optimize biomedical HIV prevention, such as pre-exposure prophylaxis among this population. Domestic violence agencies are critical collaborating partners and function as potential entry points into HIV prevention services for survivors; however, limited knowledge regarding HIV prevention has been an important barrier to advocate-led discussions. This study aimed to develop, implement, and evaluate an HIV prevention intervention for domestic violence advocates. SETTING A nonrandomized, group-based intervention with pre-intervention, immediate post-intervention, and 3-month post-intervention periods were conducted with multiple domestic violence agencies in Mississippi. METHODS Overall, 25 domestic violence advocates participated in the two-session intervention. Surveys were administered to assess pre-exposure prophylaxis knowledge, self-efficacy, subjective norms, and willingness to provide HIV prevention services to intimate partner violence survivors. Generalized estimating equations were conducted to assess change in behavioral outcomes over time. RESULTS Compared to pre-intervention, there were significant increases at immediate and 3-month post-intervention in advocates' intervention acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to provide HIV prevention information, discuss pre-exposure prophylaxis eligibility criteria, assist pre-exposure prophylaxis-engaged clients, and initiate pre-exposure prophylaxis counseling. CONCLUSION This group-based intervention enhanced domestic violence advocates' acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to offer HIV care information, discuss pre-exposure prophylaxis eligibility, assist pre-exposure prophylaxis-engaged survivors, and initiate pre-exposure prophylaxis counseling with intimate partner violence survivors. Efforts should focus on training domestic violence advocates in HIV prevention care for survivors and also include these agencies in collaborative strategies to reduce HIV incidence.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurel Sharpless
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Mauda Monger
- MLM Center for Health Education and
Equity Consulting Services, Jackson, MS, USA
| | - Trace S Kershaw
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Wendy B Mahoney
- Mississippi Coalition Against Domestic
Violence, Jackson, MS, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and
Global Public Health, Department of Medicine, University of California San Diego, La
Jolla, CA, USA
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Rao S, Reed AE, Parchem B, Edelman EJ, Magnus M, Hansen NB, Kershaw TS, Earnshaw VA, Krakower DS, Dovidio JF, Mayer KH, Underhill K, Rosenberger JG, Ogburn DF, Betancourt JR, Calabrese SK. Optimizing Provider Preexposure Prophylaxis (PrEP) Training: A Cross-Sectional Analysis of Recommendations from Providers Across the PrEP Implementation Cascade. AIDS Behav 2022; 26:218-231. [PMID: 34287754 PMCID: PMC8294250 DOI: 10.1007/s10461-021-03375-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Expanding PrEP access necessitates training that supports healthcare providers’ progression along the PrEP implementation cascade, moving from PrEP awareness to prescription. We surveyed 359 USA providers about PrEP training content and format recommendations. We examined the association between cascade location and training recommendations. Most providers were aware of PrEP (100%), willing to prescribe PrEP (97.2%), had discussed PrEP with patients (92.2%), and had prescribed PrEP (79.9%). Latent class regression analysis revealed that cascade location was associated with training recommendations. Although all providers recommended PrEP-specific content (e.g., patient eligibility), providers who were located further along the cascade also recommended more comprehensive content, including sexual history-taking and sexual and gender minority competence training. Providers further along the cascade were also more likely to recommend interactive training formats (e.g., role-playing). These insights from providers furthest along the cascade indicate the importance of including comprehensive content and interactive formats in future PrEP training initiatives.
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Affiliation(s)
- Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA.
| | - Ashley E Reed
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - Benjamin Parchem
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington DC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | | | - Kenneth H Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Kristen Underhill
- Population and Family Health and Law, Columbia University, New York City, NY, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Hyattsville, MD, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
- Department of Prevention and Community Health, Milken School of Public Health, George Washington University, Washington, DC, USA
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Wisutep P, Sirijatuphat R, Navanukroh O, Phatharodom P, Werarak P, Rattanasuwan W. Attitudes towards, knowledge about, and confidence to prescribe antiretroviral pre-exposure prophylaxis among healthcare providers in Thailand. Medicine (Baltimore) 2021; 100:e28120. [PMID: 34889271 PMCID: PMC8663816 DOI: 10.1097/md.0000000000028120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
HIV pre-exposure prophylaxis (HIV-PrEP) is an effective method for preventing HIV transmission, and it is recommended in several international guidelines. Perceptions and knowledge about HIV-PrEP prescription among healthcare providers have not been investigated in Thailand where HIV-PrEP is a novel healthcare topic. The objective of study was to determine healthcare providers' attitudes towards, knowledge about, and confidence to prescribe HIV-PrEP in Thailand.A questionnaire was administered to Thai healthcare providers during May 1, 2017 to September 5, 2018.Of the 500 questionnaires that were distributed, 460 were returned (92%). Respondents included 336 physicians (48 infectious disease [ID] physicians, 288 non-ID physicians) and 124 non-physicians (70 nurses, 35 pharmacists, and 19 others). Eighty one percent of respondents had a positive attitude towards HIV-PrEP. Multivariate analysis revealed being a non-ID physician, having prior knowledge about HIV-PrEP, believing that HIV-PrEP can reduce the number of new patients, and believing that HIV-PrEP is not associated with a higher incidence of other sexually transmitted infections were all factors significantly associated with having a positive attitude towards HIV-PrEP. The issue of most concern to respondents who had a negative attitude toward HIV-PrEP was poor patient adherence to antiviral medications. Only 57% of respondents had confidence to prescribe HIV-PrEP. Factors associated with confidence to prescribe HIV-PrEP included being an ID physician, believing that HIV-PrEP can reduce the number of new patients, believing in the safety of antiviral medications, and believing that HIV-PrEP is not associated with increased development of HIV drug resistance. The results of HIV-PrEP knowledge testing (8 questions) were categorized into good score (≥7/8) and fair score (≤6/8). Fifty five percent of participants had a good score result. Using multivariate analysis, the factors associated with a good score result were ID physician, having HIV-PrEP prescription experience, and believing that HIV-PrEP can reduce the number of new patients.Most Thai healthcare providers (81%) reported having a positive attitude towards HIV-PrEP. Successful HIV-PrEP implementation in Thailand will require steps to mitigate the described barriers, and training for healthcare providers, which will strengthen knowledge and improve both experience with and confidence to prescribe HIV-PrEP.
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Affiliation(s)
- Pruettichai Wisutep
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- School of Medicine, Institute of Medicine, Suranaree University of Technologgy, Nakornratchasima, Thailand
| | - Rujipas Sirijatuphat
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Oranich Navanukroh
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phatharajit Phatharodom
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerawong Werarak
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Winai Rattanasuwan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Keddem S, Dichter ME, Hamilton AB, Chhatre S, Sonalkar S. Awareness of HIV Preexposure Prophylaxis Among People at Risk for HIV: Results From the 2017-2019 National Survey of Family Growth. Sex Transm Dis 2021; 48:967-972. [PMID: 34108411 DOI: 10.1097/olq.0000000000001494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although daily preexposure prophylaxis (PrEP) is now widely accepted as a safe and effective method for reducing the risk of HIV in high-risk groups, uptake has been slow. The goal of this analysis was to identify factors associated with PrEP awareness among individuals at risk for HIV. METHODS This investigation analyzed data from the Centers for Disease Control and Prevention nationally representative survey, National Survey of Family Growth, for the years 2017 to 2019. Logistic regression was used to explore the relationship between PrEP awareness and demographics, HIV risk factors, and provider HIV risk screening. RESULTS Only 37% of survey respondents with an increased risk of HIV were aware of PrEP. Several segments of the at-risk population had lower odds of being aware of PrEP, including heterosexual women, heterosexual men, individuals younger than 20 years, and individuals with lower levels of education. Those who participate in sex in exchange for money or drugs had significantly lower odds of being aware of PrEP. In comparison, PrEP awareness was significantly higher among nonheterosexual men and both men and women whose partners were HIV positive. Lastly, those who had been screened by a provider for HIV risk had significantly higher odds of being aware of PrEP. CONCLUSIONS This research supports the need for policies and programs to increase awareness of PrEP, especially among certain segments of the population at increased risk for HIV.
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Affiliation(s)
| | | | | | | | - Sarita Sonalkar
- From the Perelman School of Medicine, University of Pennsylvania
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Cannon SM, Graber S, King HL, Hanashiro M, Averbach S, Moore DJ, Blumenthal J. PrEP University: A Multi-Disciplinary University-Based HIV Prevention Education Program. J Community Health 2021; 46:1213-1220. [PMID: 34106369 PMCID: PMC8595182 DOI: 10.1007/s10900-021-01007-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 12/19/2022]
Abstract
The introduction of emtricitabine/tenofovir diphosphate (FTC/TDF) as pre-exposure prophylaxis (PrEP) for HIV prevention has raised questions regarding which clinicians will serve as prescribers and how providers will be educated about this HIV prevention strategy. We piloted an HIV Prevention Education Program called PrEP University (PrEP U) to address knowledge gaps in HIV prevention among medical trainees. We examined PrEP awareness and assessed learning as a result of the program, measuring knowledge before and after the lectures with an anonymous 5-question multiple choice test. A total of 198 learners participated in PrEP University, which included 127 first year medical students, and post-graduate trainees in internal medicine (n = 23), family medicine (n = 16), OBGYN (n = 13) and pharmacy (n = 19). Prior to PrEP U, 27% of all participants were not aware of PrEP and an additional 8% were unsure if they had heard of it. Knowledge increased significantly after the education program among trainees in OBGYN (2.3 vs 3.8, p < 0.001), pharmacy (1.4 vs 2.5, p = 0.012) and school of medicine (3.3 vs 4.4, p < 0.001), with a trend seen in family medicine (2.7 vs. 3.7, p = 0.067) and internal medicine (2.7 vs 3.4, p = 0.068). Overall, an HIV Prevention Education Program was successfully administered to nearly 200 participants and resulted in improved knowledge of HIV prevention and PrEP across. Pharmacists and OBGYN physicians are two groups with an expanding role in the use of PrEP. Similar programs at other medical schools should be implemented to ensure that future physicians and pharmacists are comfortable with PrEP prescription.
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Affiliation(s)
- Sophie M Cannon
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA.
| | - Sara Graber
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA
| | - Helen L King
- Department of Internal Medicine, UT Southwestern, Dallas, TX, 75390, USA
| | - Marvin Hanashiro
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA
| | - Sarah Averbach
- Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, San Diego, CA, 92103, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA, 92103, USA
| | - Jill Blumenthal
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA
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Bunting SR, Feinstein BA, Hazra A, Sheth NK, Garber SS. Knowledge of HIV and HIV pre-exposure prophylaxis among medical and pharmacy students: A national, multi-site, cross-sectional study. Prev Med Rep 2021; 24:101590. [PMID: 34976649 PMCID: PMC8683973 DOI: 10.1016/j.pmedr.2021.101590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing HIV. However, prescription of PrEP has not reached the scale that is necessary to meet the public health need of reducing HIV incidence. A factor contributing to this slow scale-up is limited healthcare practitioners' knowledge of PrEP, making PrEP education a priority. We conducted a national, cross-sectional study of medical (allopathic and osteopathic) and pharmacy students regarding knowledge of PrEP and HIV between October 2020 and February 2021. We included 28 items in our knowledge assessment. Analysis sought to identify gaps in knowledge as well as academic and demographic correlates of knowledge. A total of 2,353 students participated in the study (response rate = 17.0%). The overall mean HIV knowledge score was 79.6% correct. Regarding specific items, 68.7% of participants believed HIV treatment was difficult because it required many pills, and 61.1% incorrectly indicated a person with an undetectable HIV viral load could transmit the virus to their sexual partners. Overall mean PrEP knowledge was 84.1%. Approximately one-third of participants did not identify HIV-negative status as a requirement to be a PrEP candidate. Gay/lesbian participants and those who were in the late-phase of training reported higher knowledge of both HIV and PrEP than did heterosexual participants and those in the early-phase of training. This study identifies specific gaps in training on HIV prevention with PrEP that must be improved in health professions education to ensure PrEP reaches its full potential in ending the HIV epidemic.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago Medical Center, Chicago, IL, USA
| | - Brian A Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medical Center, Chicago, IL, USA
| | - Neeral K Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sarah S Garber
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Whelchel K, Zuckerman AD, DeClercq J, Choi L, Rashid S, Kelly SG. HIV PrEP access and affordability: a multidisciplinary specialty pharmacy model. J Am Pharm Assoc (2003) 2021; 62:853-858. [PMID: 34916170 DOI: 10.1016/j.japh.2021.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increasing the number of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) providers expands PrEP access to more eligible patients to help end the HIV epidemic. Previous studies have noted providers perceive financial barriers as a limitation to prescribing PrEP. OBJECTIVE This study aimed to describe PrEP medication access and affordability in patients seen at a multidisciplinary PrEP clinic. METHOD We conducted a single-center, retrospective, cohort study of adults initiating tenofovir disoproxil fumarate/emtricitabine in the Vanderbilt PrEP Clinic between September 1, 2016, and March 31, 2019, with prescriptions filled by Vanderbilt Specialty Pharmacy. Data were gathered from the electronic health records and pharmacy claims. We evaluated 3 different time periods: initial evaluation to PrEP initiation, prescription of PrEP to insurance approval, and insurance approval to initiation. Treatment initiation was considered delayed when > 7 days from initial evaluation, and reasons for delay were recorded. Continuous variables are presented as median (interquartile range [IQR]), and categorical variables are presented as percentages. RESULTS We included 63 patients; most were male (97%), white (84%), and commercially insured (94%) with a median age of 38 years (IQR 29-47). Primary indication for PrEP was men who have sex with men at high risk of acquiring HIV (97%). Median time from initial appointment to treatment initiation was 7 days (IQR 4-8). Treatment delays occurred in 25% of patients and were mostly driven by patient preference (50%). Insurance prior authorization was required in 27% of patients; all were approved. Median total out-of-pocket medication costs for the entire study period were $0 (IQR $0-$0). Most patients (86%) used manufacturer copay cards. CONCLUSION In this cohort of mostly commercially insured men, the majority were able to access PrEP with low out-of-pocket costs facilitated by manufacturer assistance. Although generalizability beyond this population is limited, these results contradict perceived financial barriers to PrEP access.
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40
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Wilson K, Bleasdale J, Przybyla SM. Provider-Patient Communication on Pre-Exposure Prophylaxis (Prep) for HIV Prevention: An Exploration of Healthcare Provider Challenges. HEALTH COMMUNICATION 2021; 36:1677-1686. [PMID: 32633137 PMCID: PMC10844925 DOI: 10.1080/10410236.2020.1787927] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a once-daily pill prescribed by healthcare providers to protect patients from contracting HIV. Current data suggests that a minority of healthcare providers have ever prescribed it to clinically-eligible patients. The present study employed a social ecological framework to understand the factors that influence providers' engagement in patient-centered communication regarding PrEP. Semi-structured interviews (N = 20) with physicians, physician assistants, and nurse practitioners working in primary and specialty care practices in Western New York were thematically analyzed to understand provider-based PrEP communication challenges. Although participants never prescribed PrEP, all had clinical experience with patient populations at risk for HIV, such as people who inject drugs, men who have sex with men, transgender women, and people who exchange sex for resources. Results revealed three themes affecting provider engagement in PrEP-related discussions, which emerged across three levels of the social ecological model. At the individual level, challenges affecting provider engagement in patient-centered discussions included lacking PrEP knowledge to educate and counsel patients and discomfort with prescribing PrEP based on its perceived newness. At the interpersonal level, participants expressed varying degrees of discomfort discussing HIV risk behaviors with patients. At the organizational level, providers expressed that time constraints and managing concurrent health conditions were competing clinical priorities. Findings indicate expanding implementation efforts will require multilevel interventions that target potential PrEP-adopting healthcare providers to mitigate the perceived and real challenges surrounding provider-patient communication on PrEP for HIV prevention. Practical implications are discussed.
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Affiliation(s)
- Kennethea Wilson
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Sarahmona M Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
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41
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Krakower DS, Naja-Riese GM, Edelstein ZR, Gandhi AD, Wahnich A, Fischer MA. Academic Detailing to Increase Prescribing of HIV Pre-exposure Prophylaxis. Am J Prev Med 2021; 61:S87-S97. [PMID: 34686295 DOI: 10.1016/j.amepre.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
Although HIV pre-exposure prophylaxis can decrease new cases of HIV by up to 99%, many patients who could benefit from pre-exposure prophylaxis never receive prescriptions for it. Because pre-exposure prophylaxis is indicated for patients who do not have an infectious disease, increasing pre-exposure prophylaxis prescribing by primary care and generalist clinicians represents a key element of the Ending the HIV Epidemic in the U.S. initiative. This review provides an overview of academic detailing and how it is currently being used to increase pre-exposure prophylaxis prescribing. Academic detailing is outreach education that engages with clinicians in 1-to-1 or small group interactions focused on identifying and addressing an individual clinician's needs to increase their use of evidence-based practices. Academic detailing has been proven in multiple previous research studies, and the principles required for successful implementation include interactivity, clinical relevance of content, and focus on defined behavior change objectives. Clinician barriers to pre-exposure prophylaxis prescribing may occur in the domains of knowledge, attitudes, or behavior, and academic detailing has the potential to address all of these areas. State and local health departments have developed academic detailing programs focused on pre-exposure prophylaxis prescribing and other elements of HIV prevention-sometimes describing the approach as public health detailing. Few studies of academic detailing for pre-exposure prophylaxis have been published to date; rigorous evaluation of HIV-specific adaptations and innovations of the approach would represent an important contribution. In the setting of the COVID-19 pandemic, interest in virtual delivery of academic detailing has grown, which could inform efforts to implement academic detailing in rural communities and other underserved areas. Increasing this capacity could make an important contribution to Ending the HIV Epidemic in the U.S. and other HIV prevention efforts.
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Affiliation(s)
- Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Beth Israel Lahey Health, Boston, Massachusetts; The Fenway Institute, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gary M Naja-Riese
- San Francisco Department of Public Health, Population Health Division, Center for Learning and Innovation, San Francisco, California
| | - Zoe R Edelstein
- Prevention Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York
| | - Anisha D Gandhi
- Prevention Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York
| | - Amanda Wahnich
- Prevention Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, New York
| | - Michael A Fischer
- National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts.
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Jaiswal J, LoSchiavo C, Meanley S, Hascher K, Cox AB, Dunlap KB, Singer SN, Halkitis PN. Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe "Risk" Messaging and Normalize Preventative Health. AIDS Behav 2021; 25:3057-3073. [PMID: 33830327 PMCID: PMC8419019 DOI: 10.1007/s10461-021-03254-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of HIV prevention, but young sexual minority men face myriad barriers to PrEP uptake. Participants (n = 202) completed a survey on healthcare experiences and beliefs about HIV and PrEP. While 98% of the sample knew about PrEP, only 23.2% reported currently taking PrEP. Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV "risk", highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.
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Affiliation(s)
- J Jaiswal
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA.
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
| | - C LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
| | - S Meanley
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, 19104, USA
| | - K Hascher
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - A B Cox
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - K B Dunlap
- Department of Health Science, University of Alabama, 115 Russell Hall, 504 University Blvd, Tuscaloosa, AL, 35401, USA
| | - S N Singer
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ, 08854, USA
| | - P N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
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43
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Coleman CG, Sales JM, Escoffery C, Piper KN, Powell L, Sheth AN. Primary Care and Pre-exposure Prophylaxis Services in Publicly Funded Family Planning Clinics in the Southern United States. J Gen Intern Med 2021; 36:2958-2965. [PMID: 33443701 PMCID: PMC8481449 DOI: 10.1007/s11606-020-06509-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is underutilized by US women. Cost and resource concerns are barriers to PrEP delivery in settings that see men. Family planning clinics may be ideal PrEP delivery settings for women, but as they are not uniform in their clinical services, cost and resource concerns may vary. OBJECTIVE We examined factors that influence perceptions of costs and resources related to PrEP delivery in Title X-funded family planning clinics in Southern states, which overlaps with high HIV-burden areas. DESIGN We conducted a web-based survey among a convenience sample of clinicians and administrators of Title X clinics across 18 Southern states (DHHS regions III, IV, VI). We compared cost- and resource-related survey items and other clinic- and county-level variables between clinics by whether their clinics also provided other primary care services. We analyzed interviews for cost and resource themes. PARTICIPANTS Title X clinic staff in the South. KEY RESULTS Among 283 unique clinics, a greater proportion of clinics that also provided primary care currently provided PrEP compared with those that did not provide primary care (27.8% vs. 18.3%, p = 0.06), but this difference was not statistically significant. Among 414 respondents in clinics that were not providing PrEP, those in clinics with primary care services were more likely to respond that they had the necessary financial resources (p < 0.01) and staffing (p < 0.01) for PrEP implementation compared to those without primary care services. In interviews, respondents differed on concerns about costs of labs and staffing based on whether their clinic had concomitant primary care services or not. CONCLUSIONS Among publicly funded Southern family planning clinics, current PrEP provision was higher among clinics with concomitant primary care. Among clinics not providing PrEP, those with concomitant primary care services have lower perceived cost and resource barriers and therefore may be optimal for expanding PrEP among women.
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Affiliation(s)
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kaitlin N Piper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Leah Powell
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anandi N Sheth
- School of Medicine, Emory University, Atlanta, GA, USA.
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
- Grady Health System, Atlanta, GA, USA.
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44
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Chiarabini T, Lacombe K, Valin N. Prophylaxie préexposition au VIH (PrEP) en médecine générale : existe-t-il des freins ? SANTE PUBLIQUE 2021; 33:101-112. [PMID: 34372629 DOI: 10.3917/spub.211.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Pre-exposure chemoprophylaxis “PrEP”, a new prevention tool against HIV for high-risk populations, has been available in France since 2016 in France. The first prescription should occur in CeGIDD or hospital and, its renewal and follow-up can be made by the GP. The analysis of barriers to prescribing PrEP and its follow-up by GP is essential to guide public health actions in order to reach the objectives necessary to observe an inflection of new HIV contaminations. METHODS In this descriptive study, on general practitioners who were surveyed about their opinions and current practices of PrEP on the French territory from August to October 2018. RESULTS 351 responded to the survey, with an estimated response rate of 11%. Most clinicians (88.9%) supported PrEP but only 6.3% had provided it and 12.8% of them did PrEP monitoring. The non-providers self-assessed for 97% of them, as their knowledge of PrEP was low or very low. The significant barriers to providing PrEP among non-adopters were the lack of training received (90.6% vs 59,1% for adopters, P < 0.001), the assessment of patient as “not at risk for HIV” (29.8% vs 0%, P = 0.003), not having a private health assurance (34.7% vs 13.6%, P = 0.04), the lack of knowledge about patient sexuality (27.1% vs 4.5%, P = 0.02). The absence of a first prescription was a barrier only for PrEP follow-up and was over-represented in this group (33.3% vs 18.3% for non-adopters, P = 0.02). CONCLUSION This study shows that GPs are interested in providing PrEP despite their barriers. The management of PrEP in general practice must be improved, particularly through the training of general practitioners in the context of continuing medical education and by an institutional evolution in the extension of provide PrEP to increase the interest in global health management to overcome these barriers.
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45
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Storholm ED, Siconolfi D, Huang W, Towner W, Grant DL, Martos A, Chang JM, Hechter R. Project SLIP: Implementation of a PrEP Screening and Linkage Intervention in Primary Care. AIDS Behav 2021; 25:2348-2357. [PMID: 33624193 PMCID: PMC8556139 DOI: 10.1007/s10461-021-03197-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 01/16/2023]
Abstract
Nearly a decade after becoming formally available in the U.S., HIV pre-exposure prophylaxis (PrEP) remains underutilized by populations at risk for HIV acquisition. The next generation of PrEP research is pivoting toward implementation research in order to identify the most impactful avenues for scaling up PrEP uptake. Rapid identification of patients who may be at risk for HIV in primary care settings and the ability to provide brief consultation and prescription or referral for PrEP could help to increase PrEP uptake. The current study aimed to develop and pilot-test a PrEP screening instrument that could be integrated into the workflow of busy primary care clinics to help facilitate PrEP uptake among at-risk men. During the study, PrEP screening occurred for 12 months in two primary care clinics nested within a large integrated healthcare delivery system in Southern California. An interrupted time series analysis found a significant increase in PrEP referrals overall during the screening intervention period as compared to the preceding 12 months. Findings suggest that brief HIV risk screening in primary care is acceptable, feasible, and shows preliminary effects in increasing PrEP referral rates for Black and Hispanic/Latinx men.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, CA, USA.
| | | | | | - William Towner
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Deborah Ling Grant
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Alexander Martos
- Southern California Permanente Medical Group, Los Angeles Medical Center Department of Consulting Services, Los Angeles, CA, USA
| | - John M Chang
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rulin Hechter
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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46
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Examining the Factors Affecting PrEP Implementation Within Community-Based HIV Testing Sites in Florida: A Mixed Methods Study Applying the Consolidated Framework for Implementation Research. AIDS Behav 2021; 25:2240-2251. [PMID: 33403517 DOI: 10.1007/s10461-020-03152-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
HIV testing/counseling is a critical point during which non-clinical staff could intervene, discuss and/or refer clients for pre-exposure prophylaxis (PrEP). This analysis investigated the contextual factors affecting PrEP implementation within HIV testing sites. Two generalized linear mixed models were conducted to estimate PrEP implementation as a function of constructs from the Consolidated Framework for Implementation Research (CFIR). Qualitative interviews were analyzed thematically. Data integration occurred via joint analysis and triangulation. Constructs from the CFIR domain Characteristics of Individuals did not predict PrEP implementation when controlling for demographic characteristics; qualitative data signaled divergent findings in PrEP knowledge. Within the CFIR domains Inner and Outer Settings, relevant priority and available resources predicted PrEP implementation; qualitative data confirmed the importance of available resources and provided insight into the impact of cosmopolitanism and leadership. Addressing the contextual factors that affect PrEP implementation may help HIV testing staff to better implement PrEP programs.
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47
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Moore E, Kelly SG, Alexander L, Luther P, Cooper R, Rebeiro PF, Zuckerman AD, Hargreaves M, Bourgi K, Schlundt D, Bonnet K, Pettit AC. Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis. J Prim Care Community Health 2021; 11:2150132720984416. [PMID: 33356793 PMCID: PMC7768326 DOI: 10.1177/2150132720984416] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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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Affiliation(s)
- Emily Moore
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sean G Kelly
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | - Kassem Bourgi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - April C Pettit
- Vanderbilt University Medical Center, Nashville, TN, USA
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48
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Cui S, Ding H, Huang X, Wang H, Tang W, Leuba SI, Ye Z, Jiang Y, Geng W, Xu J, Shang H. Factors Influencing Clinicians' Willingness to Prescribe Pre-exposure Prophylaxis for Persons at High Risk of HIV in China: Cross-sectional Online Survey Study. JMIR Public Health Surveill 2021; 7:e24235. [PMID: 34085941 PMCID: PMC8214180 DOI: 10.2196/24235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/13/2020] [Accepted: 04/15/2021] [Indexed: 02/06/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective HIV prevention measure. Clinicians play a crucial role in PrEP implementation, and their knowledge, attitudes, and career experience may affect their willingness to prescribe PrEP. However, little is known about the attitudes and willingness of clinicians to prescribe PrEP in countries without PrEP-specific guidelines. Objective We aimed to determine the factors associated with clinicians being willing to prescribe PrEP in China. Methods Between May and June 2019, we conducted an online cross-sectional survey of clinicians in 31 provinces across the six administrative regions in China on the WeChat smartphone app platform. Multivariable logistic regression was used to determine factors associated with willingness to prescribe PrEP. Results Overall, 777 HIV clinicians completed the survey. Most of the respondents had heard of PrEP (563/777, 72.5%), 31.9% (248/777) thought that PrEP was extremely effective for reducing the risk of HIV infection, and 47.2% (367/777) thought that it was necessary to provide PrEP to high-risk groups. After adjusting for age, gender, ethnicity, and educational background of the clinicians, the following factors significantly increased the odds of the clinicians being willing to prescribe PrEP: having worked for more than 10 years, compared to 5 years or less (adjusted odds ratio [aOR] 2.82, 95% CI 1.96-4.05); having treated more than 100 patients living with HIV per month, compared to 50 patients or fewer (aOR 4.16, 95% CI 2.85-6.08); and having heard of PrEP (aOR 7.32, 95% CI 4.88-10.97). Clinicians were less likely to be willing to prescribe PrEP if they were concerned about poor adherence to PrEP (aOR 0.66, 95% CI 0.50-0.88), the lack of PrEP clinical guidelines (aOR 0.47, 95% CI 0.32-0.70), and the lack of drug indications for PrEP (aOR 0.49, 95% CI 0.32-0.76). Conclusions About half of all clinicians surveyed were willing to prescribe PrEP, but most surveyed had a low understanding of PrEP. Lack of PrEP clinical guidelines, lack of drug indications, and less than 11 years of work experience were the main barriers to the surveyed clinicians’ willingness to prescribe PrEP. Development of PrEP clinical guidelines and drug indications, as well as increasing the availability of PrEP training, could help improve understanding of PrEP among clinicians and, thus, increase the number willing to prescribe PrEP.
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Affiliation(s)
- Sitong Cui
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Shenzhen Third People's Hospital, Shenzhen, China
| | - Weiming Tang
- Project-China, University of North Carolina at Chapel Hill, Guangzhou, China
| | - Sequoia I Leuba
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zehao Ye
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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49
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Addressing Unhealthy Alcohol Use and the HIV Pre-exposure Prophylaxis Care Continuum in Primary Care: A Scoping Review. AIDS Behav 2021; 25:1777-1789. [PMID: 33219492 DOI: 10.1007/s10461-020-03107-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/19/2022]
Abstract
Individuals with unhealthy alcohol use are at increased risk for HIV acquisition and may benefit from receiving HIV pre-exposure prophylaxis (PrEP) in primary care settings. To date, literature synthesizing what is known about the impact of unhealthy alcohol use on the PrEP care continuum with a focus on considerations for primary care is lacking. We searched OVID Medline and Web of Science from inception through March 19, 2020, to examine the extent, range, and nature of research on PrEP delivery among individuals with unhealthy alcohol use in primary care settings. We identified barriers and opportunities at each step along the PrEP care continuum, including for specific populations: adolescents, people who inject drugs, sex workers, and transgender persons. Future research should focus on identification of candidate patients, opportunities for patient engagement in novel settings, PrEP implementation strategies, and stigma reduction.
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50
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Gutierrez JI, Dubov A, Altice FL, Vlahov D. Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study. Mil Med Res 2021; 8:32. [PMID: 34006328 PMCID: PMC8132436 DOI: 10.1186/s40779-021-00323-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) infection, but its use remains low among U.S. military men who have sex with men (MSM), likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population. METHODS HIV-negative military MSM were recruited through a closed, Lesbian, Gay, Bisexual, and Transgendered (LGBT) military social media group. The survey was anonymous, and consisted of five experimentally varied attributes in service delivery: dosing method, provider type, visit location, lab work evaluation location, and dispensing venue. Relative importance and part-worth utility scores were generated using hierarchical bayes (HB) estimation, and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios. RESULTS A total of 429 participants completed the survey. Among the eight scenarios with varying attributes, the most preferred scenario featured a daily tablet, PrEP injection or implant, along with a military provider, smartphone/telehealth visit, and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge, and to provide interactions sensitive to sexual identity and mental health. CONCLUSION A PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Long-acting implants and injections are also desired.
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Affiliation(s)
- José I Gutierrez
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA. .,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, San Francisco, CA, 94118, USA.
| | - Alex Dubov
- Loma Linda University, Griggs Hall 11065, Loma Linda, CA, 92350, USA
| | - Frederick L Altice
- Yale School of Medicine, Section of Infectious Diseases, 135 College Street, Suite 323, New Haven, CT, 06510, USA.,Department of Epidemiology-Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
| | - David Vlahov
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.,Department of Epidemiology-Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
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