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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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Carter G, Tavares T. PrEP prescription in indiana 2017-2022: Implications for clinical practice. Res Nurs Health 2024; 47:49-59. [PMID: 37963774 DOI: 10.1002/nur.22354] [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: 05/31/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023]
Abstract
The Ending the HIV Epidemic initiative is poised to eradicate HIV through increasing screening and linkage to care. Despite this, the rate of HIV testing remains inadequate, and effective preventive measures like pre-exposure prophylaxis (PrEP) are not adequately prescribed. A retrospective chart review was conducted to include 2017 through July 2022 from a large nonprofit health care system in the Midwest. Inclusion criteria included an HIV-negative diagnosis between 2017 and July 2022. Additional information includes gender, age, race/ethnicity, the primary payment method, the facility where screening occurred, history of PrEP prescription, and the provider who documented sexual health screening. Most patients were female (73%, n = 3366), followed by 27% (n = 1242) who identified as male. The majority identified as white (52.4%, n = 2415), and patients who identified as Black represented 45.3% (n = 2087) of the sample. Of the participants in the sample, n = 3030 (65.8%) did not have a documented sexual health assessment at the time of HIV screening. Black patients were 0.40 times less likely to report a PrEP prescription than their white counterparts. Patients screened by the provider and identified with infectious disease via a sexual mode of transmission demonstrated three times increased odds of being prescribed PrEP. This research highlights the importance of updating medical records systems to capture salient sexual health factors. Ongoing professional development should be made readily available so providers can conduct comprehensive sexual health assessments.
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Affiliation(s)
- Gregory Carter
- Indiana University School of Nursing, Bloomington, Indiana, USA
- The Kinsey Institute, Bloomington, Indiana, USA
- Rural Center for AIDS and STD Prevention, Indiana, USA
| | - Taran Tavares
- Indiana University School of Nursing, Bloomington, Indiana, USA
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Owens C, Gray SJ, Carter K, Hoffman M, Mullen C, Hubach RD. Implementation Facilitators and Barriers for Primary Care Providers Prescribing Daily Oral PrEP to Adolescents in the United States. AIDS Patient Care STDS 2023; 37:379-393. [PMID: 37566536 DOI: 10.1089/apc.2023.0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
Primary care providers (PCPs) are critical in prescribing human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) to adolescents at risk of HIV. More research is needed to identify facilitators and barriers PCPs encounter in prescribing PrEP to eligible adolescents post-Food and Drug Administration (FDA) approval. This online cross-sectional survey examined the PrEP implementation facilitators and barriers among a national sample of PCPs in the United States. PCPs (n = 502) specializing in family medicine or pediatrics were recruited from a Qualtrics panel from July 15 to August 9, 2022. We analyzed the collected data using content analysis and applied the Expert Recommendations for Implementing Change (ERIC) to codebook creation and data analysis. We conducted a Fisher's exact chi-square test of independence to compare facilitator and barrier prevalence differences between participants who had and had not prescribed PrEP to an adolescent patient. Results demonstrate that (1) distributing prescriber-focused educational materials, (2) involving parents, (3) changing liability laws, (4) enhancing adolescent PrEP uptake and adherence, (5) changing clinical resources, and (6) using mass/social media to change community norms might be strategies that influence PCPs prescribing PrEP to eligible adolescent patients. Results from this study could facilitate the planning of hybrid implementation-effectiveness trials designed to determine the acceptability, feasibility, and effectiveness of implementation strategies in improving the practices of PCPs prescribing PrEP to at-risk adolescents.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Samuel J Gray
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Kaileigh Carter
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Matt Hoffman
- School of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Cody Mullen
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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D’Angelo AB, Mirzayi C, Carneiro PB, Grov C. Changes in Cost and Insurance Challenges to Cover PrEP Between 2019 and 2021. J Acquir Immune Defic Syndr 2023; 93:116-125. [PMID: 36881835 PMCID: PMC10293025 DOI: 10.1097/qai.0000000000003180] [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: 07/25/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Pre-Exposure Prophylaxis (PrEP) use continues lag estimated need among gay and bisexual men in the United States. Studies report that challenges paying for PrEP may undermine continued use. Our study aimed to measure these challenges over time. METHODS Data were taken from a US national cohort study of cisgender gay and bisexual men and transgender individuals aged 16-49 years. We analyzed data from PrEP-using participants between 2019 and 2021 and observed cost-related and insurance-related challenges participants experienced while on PrEP across time points. We report McNemar and Cochrane Q test statistics to compare differences between groups by year(s). RESULTS In 2019, 16.5% (n = 828/5013) of participants were on PrEP; by 2020, 21% (n = 995/4727) were on PrEP, and by 2021, 24.5% (n = 1133/4617) were on PrEP. The proportion of those experiencing challenges paying for PrEP care decreased significantly across time points for clinical appointments, laboratory work, and prescriptions. Those experiencing insurance and copay approval issues did not change significantly. Although not statistically significant, the only proportion that increased over time was those reporting PrEP-related insurance approval issues. In a post hoc analysis, we found that those reporting PrEP use in the past year who were not currently on PrEP were significantly more likely to report experiencing most PrEP challenges, when compared with current PrEP users. DISCUSSION We found significant reductions in insurance and cost-related challenges between 2019 and 2021. However, those who discontinued PrEP within the past year reported greater challenges paying for PrEP, suggesting that cost and insurance issues may undermine PrEP persistence.
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Affiliation(s)
- Alexa B. D’Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY b
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY
| | - Chloe Mirzayi
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY b
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY
| | - Pedro B. Carneiro
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY b
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY b
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY
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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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Barry MP, Austin EJ, Bhatraju EP, Glick SN, Stekler JD, Tung EL, Hansen RN, Williams EC, Gojic AJ, Pickering EI, Tsui JI. Qualitative inquiry into perceptions of HIV pre-exposure prophylaxis among people who inject drugs living with hepatitis C in Seattle, WA, USA. Harm Reduct J 2022; 19:121. [PMID: 36320005 PMCID: PMC9628120 DOI: 10.1186/s12954-022-00706-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/07/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The incidence of HIV among persons who inject drugs (PWID) in the USA has been increasing since 2014, signaling the need to identify effective ways to engage PWID in HIV prevention services, namely pre-exposure prophylaxis (PrEP). Yet, the uptake of PrEP in this population is minimal compared to other populations at risk of HIV acquisition. In this work, we sought to explore knowledge, attitudes, and perspectives of PrEP acceptability among PWID. METHODS In the context of a pilot study to explore the acceptability of pharmacy-based hepatitis C virus (HCV) treatment, we conducted semi-structured interviews (n = 24) and focus groups (n = 4, 16 participants) with people who were living with HCV and reported active injection drug use (≤ 90 days since last use). Participants were asked open-ended questions about their familiarity with and motivation to use PrEP. As part of a sub-analysis focused on PrEP, qualitative data were analyzed using a Rapid Assessment Process, where three coders used structured templates to summarize qualitative data and iteratively reviewed coded templates to identify themes. Participants also completed short quantitative questionnaires regarding drug use history and attitudes toward health concerns. RESULTS Forty-seven percent of participants expressed having little or no concern regarding HIV acquisition. Targeted analyses focused on HIV prevention identified three themes, which help characterize behavioral determinants of nonadoption. First, knowledge of PrEP was limited among PWID and influenced by infrequent open community discussions around HIV risk. Second, PWID perceived sexual behaviors-but not injection drug use-as a motivator for HIV risk prevention. Finally, PWID identified many individual and environmental barriers that hinder PrEP uptake. CONCLUSION Among PWID, PrEP is rarely discussed and concerns about the feasibility of using daily PrEP are common. Taken with the prevalent perception that drug use is not a high risk for HIV acquisition, our findings point to opportunities for public health work to target PrEP education to PWID and to leverage other successful interventions for PWID as an opportunity to provide PrEP to this vulnerable population.
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Affiliation(s)
- Michael P Barry
- Department of Epidemiology, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 8th Floor, Box 351619, Seattle, WA, 98195, USA
- HIV/STD Program, Public Health - Seattle and King County, 401 5th Ave. Suite 1300, Seattle, WA, 98104, USA
| | - Elizabeth J Austin
- Department of Health Systems and Population Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 4th Floor, Box 351621, Seattle, WA, 98195, USA
| | - Elenore P Bhatraju
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA
| | - Sara N Glick
- HIV/STD Program, Public Health - Seattle and King County, 401 5th Ave. Suite 1300, Seattle, WA, 98104, USA
- Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific St., Box 356423, Seattle, WA, 98195, USA
| | - Joanne D Stekler
- Department of Epidemiology, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 8th Floor, Box 351619, Seattle, WA, 98195, USA
- Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific St., Box 356423, Seattle, WA, 98195, USA
- Department of Global Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 7th Floor, Seattle, WA, 98195, USA
| | - Elyse L Tung
- Kelley-Ross Pharmacy Group, Seattle, WA, USA
- Department of Pharmacy, University of Washington, H375 Health Science Building, Box 357630, Seattle, WA, 98195-7630, USA
| | - Ryan N Hansen
- Department of Health Systems and Population Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 4th Floor, Box 351621, Seattle, WA, 98195, USA
- Kelley-Ross Pharmacy Group, Seattle, WA, USA
- Department of Pharmacy, University of Washington, H375 Health Science Building, Box 357630, Seattle, WA, 98195-7630, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 4th Floor, Box 351621, Seattle, WA, 98195, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound, 1660 South Columbia Way, Building 101, Room 4E51, Seattle, WA, 98108, USA
| | - Alexander J Gojic
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA
| | - Eleanor I Pickering
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT, 06510, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA.
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Tidd M, Shiyanbola O, Ford JH, Richert L. Assessing the use of an infographic on pre-exposure prophylaxis for Wisconsin community pharmacists. J Am Pharm Assoc (2003) 2022; 62:1897-1903.e4. [PMID: 35989150 PMCID: PMC11008566 DOI: 10.1016/j.japh.2022.07.010] [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: 03/24/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) treatments reduce the risk of contracting human immunodeficiency virus (HIV). However, despite proven effectiveness, PrEP use remains low among populations at risk of contracting HIV. Successful PrEP uptake includes developing partnerships with health care providers to implement PrEP-related tools and interventions. Pharmacists are uniquely positioned health professionals who can provide PrEP services in the community, such as pharmacy-led PrEP clinics, to increase uptake, adherence, and retention. Unfortunately, prior evidence shows that not all pharmacists have enough knowledge about PrEP to provide effective care, resulting in low confidence and discomfort in PrEP-related patient consultations. OBJECTIVES This study aimed to assess Wisconsin community pharmacists' intentions of utilizing an infographic on PrEP for HIV prevention to educate themselves on PrEP and in consultations with patients starting PrEP. METHODS An adaptative survey, using the Theory of Planned Behavior, was conducted to assess pharmacists' intentions by measuring their attitudes, subjective norms, and perceived behavioral control. The Fisher exact tests were performed to examine associations between the 3 theoretical constructs against intentions. RESULTS Pharmacists reported high intentions of utilizing the infographic to educate themselves (62%) and counsel patients starting PrEP (54%). Their attitudes, subjective norms, and perceived behavioral controls were all significantly associated with their intentions. However, their intentions were reported lower than their attitudes, subjective norms, and perceived behavioral control, suggesting that additional factors may influence intentions that were not measured in this study. CONCLUSION The results from this study demonstrate Wisconsin community pharmacists' intentions of using an infographic on PrEP for HIV prevention in practice while measuring their attitudes, subjective norms, and perceived behavioral control. Future research is warranted to explore adapting and using the infographic to better understand its influence in improving pharmacy care among HIV-negative individuals.
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Jaramillo J, Pagkas-Bather J, Waters K, Shackelford LB, Campbell RD, Henry J, Grandberry V, Ramirez LF, Cervantes L, Stekler J, Andrasik MP, Graham SM. Perceptions of Sexual Risk, PrEP Services, and Peer Navigation Support among HIV-Negative Latinx and Black Men who have Sex with Men (MSM) Residing in Western Washington. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1058-1068. [PMID: 36387840 PMCID: PMC9642978 DOI: 10.1007/s13178-021-00595-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 05/27/2023]
Abstract
Introduction HIV PrEP (pre-exposure prophylaxis) is underutilized among Latinx and Black men who have sex with men (MSM) in the United States. Although peer navigation approaches may increase PrEP uptake and adherence, it remains unclear what strategies work best for MSM of color. Methods From July 2017 to August 2018, we conducted semi-structured in-depth interviews with 25 purposively sampled Latinx and Black cisgender MSM to evaluate how the intersectionality of race/ethnicity, sexual orientation, and other identities influenced men's views on PrEP in general and on peer navigation specifically. Thematic analysis was used to identify and analyze emergent themes. Results Emergent themes included: (1) awareness of vulnerability in intimate relationships; (2) barriers to PrEP initiation including perceived side effects, stigma, and financial concerns; (3) a wish to connect with other Latinx and Black MSM in a health and prevention space; and (4) the desire for peer matching based on identity considerations and lived experience. Younger men and Spanish-speaking Latinx men were most interested in peer navigation to access PrEP, while bisexual men had confidentiality concerns. Conclusions In our study, Latinx and Black MSM viewed peer navigation services favorably, especially if they addressed men's desire to connect with other MSM of color. Policy Implications Developing culturally-congruent peer navigation programming could help improve PrEP uptake and care engagement for Latinx and Black MSM. Programs should recruit peers from the racial/ethnic minority communities most impacted by HIV and prioritize matching peers to clients based on identity concerns, needs, and preferences.
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Affiliation(s)
- Jahn Jaramillo
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jade Pagkas-Bather
- Department of Medicine, Section of Infectious Diseases & Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Kimiam Waters
- College of Arts & Sciences, University of Washington, Seattle, WA, USA
| | | | | | - Jsani Henry
- Public Health- Seattle & King County HIV/STD Program, Seattle, WA, USA
| | | | | | | | - Joanne Stekler
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Michele P. Andrasik
- Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutchinson Vaccine and Infectious Disease Division, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Susan M. Graham
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Feinstein BA, Chang CJ, Bunting SR, Bahrke J, Hazra A, Garber SS. Willingness to Prescribe PrEP to Bisexual Men Depends on Genders of Their Past Partners: A Study of Medical Students in the USA. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2535-2547. [PMID: 35689147 DOI: 10.1007/s10508-022-02337-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
Bisexual men are at increased risk for HIV compared to heterosexual men but unlikely to use pre-exposure prophylaxis (PrEP). Given that biases may influence whether bisexual men are prescribed PrEP, we examined whether medical students' decision-making was influenced by the genders of a bisexual male patient's partners. Medical students (N = 718) were randomized to one of nine conditions where they answered questions about a bisexual male patient after reviewing his electronic medical record. We manipulated the gender of his current partner (none, male, female) and the genders of his past partners (male, female, both). Current partners were described as living with HIV and not yet virally suppressed, past partners were described as being of unknown HIV-status, and condom use was described as intermittent with all partners. When the patient was not in a current relationship, perceived HIV risk and likelihood of prescribing PrEP were lowest if he only had female partners in the past. When he was in a current relationship, perceived HIV risk and likelihood of prescribing PrEP did not differ based on current or past partners' genders. In addition, identification as a PrEP candidate, perceived likelihood of adherence, and perceived likelihood of engaging in condomless sex if prescribed were lower when the patient was not in a current relationship. Medical students appropriately prioritized the status of the partner living with HIV, but their decision-making was influenced by past partner genders when the patient was not in a current relationship. Medical students may require additional education to ensure they understand PrEP eligibility criteria and make decisions based on patients' individual presentations.
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Affiliation(s)
- Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL, 60064, USA.
| | - Cindy J Chang
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL, USA
| | - Jesse Bahrke
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd., North Chicago, IL, 60064, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sarah S Garber
- College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Salabarría-Peña Y, Douglas C, Brantley M, Johnson AK. Informing the future of PrEP navigation: Findings from a five-site cluster evaluation. EVALUATION AND PROGRAM PLANNING 2022; 90:101999. [PMID: 34503854 PMCID: PMC11288482 DOI: 10.1016/j.evalprogplan.2021.101999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
The PrEP (pre-exposure prophylaxis) Implementation, Data to Care and Evaluation (PrIDE) demonstration project funded 12 health departments (HD) (2016-2019) to scale up PrEP among sexual minorities at risk for HIV. Each health department (HD) conducted an evaluation of at least one local strategy, and, to maximize crossvalidation, an adapted cluster evaluation approach was employed. As a result, five HDs with similar evaluation questions regarding PrEP navigation were identified. Overall, PrEP navigation fit in well with HD clinics and community-based organizations. A hybrid model of patient, peer, and systems navigation linking clients to PrEP and social services was commonly used. Although there were no differences by setting regarding linking clients to PrEP providers, one HD demonstrated that having all PrEP services in the same location contributed the most to PrEP uptake. Navigator skill for case management and rapport building facilitated navigation, whereas staff turnover and lack of client health insurance were challenges. While one HD in a non-Medicaid expansion state was affected by health insurance issues the most, another HD demonstrated that providing payment assistance increased client PrEP use. The findings pinpoint PrEP navigation hybrid modality and having health insurance as promising strategies to increase PrEP uptake among priority groups.
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Affiliation(s)
- Yamir Salabarría-Peña
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA 30329, USA.
| | - Chelsea Douglas
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS US8-5, Atlanta, GA 30329, USA.
| | - Meredith Brantley
- Tennessee Department of Health, Andrew Johnson Tower, 4th Floor, 710 James Robertson Pkwy, Nashville, TN 37243, USA.
| | - Amy K Johnson
- Ann & Robert H. Lurie Children's Hospital and Northwestern University, 225 East Chicago Avenue, Box 161, Chicago, IL 60611-2605, USA.
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Stanton MC, Ali SB, the SUSTAIN Center Team. A typology of power in implementation: Building on the exploration, preparation, implementation, sustainment (EPIS) framework to advance mental health and HIV health equity. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895211064250. [PMID: 37091105 PMCID: PMC9978699 DOI: 10.1177/26334895211064250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Persistent inequities in HIV health are due, in part, to barriers to successful HIV-related mental health intervention implementation with marginalized groups. Implementation Science (IS) has begun to examine how the field can promote health equity. Lacking is a clear method to analyze how power is generated and distributed through practical implementation processes and how this power can dismantle and/or reproduce health inequity through intervention implementation. The aims of this paper are to (1) propose a typology of power generated through implementation processes, (2) apply this power typology to expand on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to advance HIV and mental health equity and (3) articulate questions to guide the explicit examination and distribution of power throughout implementation. Methods This paper draws on the work of an Intermediary Purveyor organization implementing trauma-informed care and harm reduction organizational change with HIV service organizations. The expanded framework was developed through analyzing implementation coaching field notes, grant reporting, and evaluation documents, training feedback, partner evaluation interviews, and existing implementation literature. Results The authors identify three types of power working through implementation; (1) discursive power is enacted through defining health-related problems to be targeted by intervention implementation, as well as through health narratives that emerge through implementation; (2) epistemic power influences whose knowledge is valued in decision-making and is recreated through knowledge generation; and (3) material power is created through resource distribution and patterns of access to health resources and acquisition of health benefits provided by the intervention. Decisions across all phases and related to all factors of EPIS influence how these forms of power striate through intervention implementation and ultimately affect health equity outcomes. Conclusions The authors conclude with a set of concrete questions for researchers and practitioners to interrogate power throughout the implementation process. Plain language summary Over the past few years, Implementation Science researchers have committed increased attention to the ways in which the field can more effectively address health inequity. Lacking is a clear method to analyze how implementation processes themselves generate power that has the potential to contribute to health inequity. In this paper, the authors describe and define three types of power that are created and distributed through intervention implementation; discursive power, epistemic power, and material power. The authors then explain how these forms of power shape factors and phases of implementation, using the well-known EPIS (exploration, preparation, implementation, sustainment) framework. The authors draw from their experience working with and Intermediary Purveyor supporting HIV service organizations implementing trauma-informed care and harm reduction organizational change projects. This paper concludes with a set of critical questions that can be used by researchers and practitioners as a concrete tool to analyze the role of power in intervention implementation processes.
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Affiliation(s)
- Megan C. Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, Willimantic, CT, USA
| | - Samira B. Ali
- Graduate College of Social Work, University of Houston, Houston, TX, USA
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12
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George WH, Blayney JA, Stappenbeck CA, Davis KC. The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda. AIDS Behav 2021; 25:347-364. [PMID: 34244871 DOI: 10.1007/s10461-021-03351-4] [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: 06/10/2021] [Indexed: 11/29/2022]
Abstract
HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.
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Affiliation(s)
- William H George
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA.
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Cynthia A Stappenbeck
- Department of Psychology, Center for Research on Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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13
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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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14
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Zhu W, Huang YLA, Kourtis AP, Hoover KW. Trends in the Number and Characteristics of HIV Pre-Exposure Prophylaxis Providers in the United States, 2014-2019. J Acquir Immune Defic Syndr 2021; 88:282-289. [PMID: 34651603 PMCID: PMC8568068 DOI: 10.1097/qai.0000000000002774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number and characteristics of pre-exposure prophylaxis (PrEP) health care providers in the United States have not been reported. METHODS We analyzed a national pharmacy database that included >90% of all prescriptions dispensed by retail pharmacies and 60%-86% dispensed by mail-order outlets. We estimated the number of PrEP providers by year, provider type, physician specialty, and geographic location. We also measured the Gini coefficients for the distribution of PrEP patients among providers. RESULTS The number of PrEP providers increased from 9621 in 2014 to 65,822 in 2019. In 2019, 68.1% of PrEP providers were physicians. The proportion of nurse practitioners or physician assistants increased from 18.0% in 2014 to 29.7% in 2019. Among all the US health care providers, those who prescribed PrEP increased from 0.7% in 2014 to 4.3% in 2019. Among all general practice/family medicine physicians, the percentage of who prescribed PrEP increased from 1.8% in 2014 to 13.6% in 2019 and from 14.2% to 34.2% among infectious disease physicians. The ratio of PrEP providers to 100 persons with PrEP indications was lowest in the South with 4.4. The Gini coefficient for the distribution of PrEP patients among providers was 0.75 in 2019, with 50% of the PrEP patients prescribed PrEP by 2.2% of PrEP providers. CONCLUSIONS An increasing number of providers prescribed PrEP during 2014-2019. The South had the largest number of new HIV diagnoses and greatest need for HIV prevention but had less PrEP service capacity compared with other regions. Expanded access to PrEP services is needed in the United States.
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Affiliation(s)
- Weiming Zhu
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Ya-Lin A. Huang
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Athena P. Kourtis
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Karen W. Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA
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15
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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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16
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Stewart J, Baeten JM. HIV pre-exposure prophylaxis and sexually transmitted infections: intersection and opportunity. Nat Rev Urol 2021; 19:7-15. [PMID: 34697493 DOI: 10.1038/s41585-021-00527-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/29/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention, but PrEP does not protect against other sexually transmitted infections (STIs). Rates of STIs are rising worldwide, with notably high incidences among PrEP-using men who have sex with men in high-income countries; in low-income and middle-income countries, data are sparse, but results from a limited number of studies among African women initiating and taking PrEP have shown high STI prevalence and incidence. Efforts aimed at markedly reducing HIV in populations worldwide include a major focus on increasing PrEP use, along with improving HIV testing and treatment in order to eliminate HIV transmission. Together, these efforts could augment continued expansion of the global STI epidemic, but they could alternatively create an opportunity to improve STI control, including the development of comprehensive sexual health programmes and research to develop new STI prevention strategies. The introduction of PrEP globally has been characterized by challenges and many successes, and its role as part of a range of robust strategies to reduce HIV infections is clear. Looking ahead, understanding rising rates of curable STIs and their relationship to HIV prevention, and considering the future directions for synergies in PrEP and STI prevention will be integral to improving sexual health.
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Affiliation(s)
- Jenell Stewart
- Department of Medicine, University of Washington, Seattle, WA, USA. .,Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Jared M Baeten
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Epidemiology, University of Washington, Seattle, WA, USA
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17
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Marcus JL, Levine K, Sewell WC, Solleveld P, Mayer KH, Krakower DS. Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide for Human Immunodeficiency Virus Preexposure Prophylaxis at a Boston Community Health Center. Open Forum Infect Dis 2021; 8:ofab372. [PMID: 34631926 PMCID: PMC8496521 DOI: 10.1093/ofid/ofab372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Efforts to end the human immunodeficiency virus (HIV) epidemic may be
threatened if limited preexposure prophylaxis (PrEP) resources are funneled
from tenofovir disoproxil fumarate with emtricitabine (TDF/FTC) to tenofovir
alafenamide with emtricitabine (TAF/FTC) without proportional clinical
benefits. Methods The study population was patients at a Boston community health center who
were assigned male sex at birth, aged ≥18 years, and prescribed
TDF/FTC for PrEP in the 12 months before TAF/FTC approval (October 2019). We
determined the frequency of switching to TAF/FTC in the 12 months after
approval, including clinically indicated switching (ie, creatinine clearance
<60 mL/minute or reduced bone density), potentially unnecessary
switching (ie, no indications for switching and no cardiovascular risk
factors), and potentially harmful switching (ie, no indications for
switching and either obesity or dyslipidemia). Results Of 2892 TDF/FTC users, mean age was 38 years, 96.0% were cisgender men, and
78.9% were white. A total of 343 (11.9%) switched to TAF/FTC. Based on
documented renal, bone, and cardiovascular risk factors, we identified 24
(7.0%) with clinically indicated switching, 271 (79.0%) with potentially
unnecessary switching, and 48 (14.0%) with potentially harmful switching.
When indications for switching additionally included hypertension, diabetes,
and creatinine clearance 60–70 mL/minute, 27.1% of switching was
clinically indicated. Conclusions Few who switched to TAF/FTC had documented indications for switching,
although some appear to have been switched in anticipation of indications
developing. As generic TDF/FTC is further discounted, provider education and
patient decision aids are needed to facilitate selection of PrEP medications
that is both clinically sound and cost-effective.
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Affiliation(s)
- Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA
| | | | - Whitney C Sewell
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Patricia Solleveld
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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18
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McMahan VM, Violette LR, Andrasik MP, Martin A, Garske L, Stekler JD. 'I make sure my doctor doesn't know that I use meth': perceived barriers to pre-exposure prophylaxis (PrEP) uptake among community peer educators in Seattle (WA, USA). Sex Health 2021; 17:29-37. [PMID: 31954432 DOI: 10.1071/sh19083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022]
Abstract
Background HIV disproportionately affects cisgender men and transgender people who have sex with men (MSM/TG) and use methamphetamine. Pre-exposure prophylaxis (PrEP) uptake has been slow in this group. It is important to understand perceptions about PrEP and barriers to its use among MSM/TG who use methamphetamine to reduce new HIV infections. METHODS We conducted four focus groups with peer educators of a harm reduction program. We assessed their perspectives of PrEP and barriers across the PrEP continuum among MSM/TG who use methamphetamine. RESULTS Notably, stigma related to the multiple marginalised identities of MSM/TG who use methamphetamine (e.g. MSM/TG-related stigma, methamphetamine-related stigma) was a barrier at each step. We developed a framework that combined the PrEP continuum and a stigma-based treatment cascade to explore these themes and describe the effects of stigma on PrEP engagement. Methamphetamine-related barriers were also identified. CONCLUSIONS The findings of this study emphasise the importance of incorporating stigma reduction into PrEP delivery for MSM/TG who use methamphetamine.
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Affiliation(s)
- Vanessa M McMahan
- Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA; and Corresponding author.
| | - Lauren R Violette
- Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Michele P Andrasik
- Department of Global Health, University of Washington, 1510 San Juan Road, Seattle, WA, 98195 USA; and Fred Hutch, HIV Vaccine Trials Network, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - Aleks Martin
- Project NEON, Seattle Counseling Service, 1216 Pine Street, Suite 300, Seattle, WA, 98101, USA
| | - Lindsay Garske
- Project NEON, Seattle Counseling Service, 1216 Pine Street, Suite 300, Seattle, WA, 98101, USA
| | - Joanne D Stekler
- Department of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA; and Department of Global Health, University of Washington, 1510 San Juan Road, Seattle, WA, 98195 USA; and Department of Epidemiology, University of Washington, 1959 NE Pacific Street Seattle, WA, 98195 USA
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19
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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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20
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Tailored HIV Pre-exposure Prophylaxis (PrEP) Intervention Needs from a Latent Class Analysis Among U.S. Healthcare Providers. AIDS Behav 2021; 25:1751-1760. [PMID: 33216244 DOI: 10.1007/s10461-020-03105-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
Interventions are needed to expand HIV pre-exposure prophylaxis (PrEP) prescribing practices among healthcare providers, but research classifying providers to determine tailored intervention needs is lacking. Providers reported demographics, factors related to HIV treatment and prevention experience, and PrEP-related factors such as knowledge and community protection beliefs via online survey. Latent class analysis grouped providers with similar patterns of HIV prevention- and treatment-related care and tested for associations with demographics and PrEP-related factors. Three distinct classes of providers emerged: (1) PrEP naïve, (2) PrEP aware, and (3) PrEP prescribers. Providers with lower community protection beliefs and staff capacity were more likely to be classified as PrEP naïve compared to aware (ps < 0.05). Providers with concerns about PrEP-related tasks and staff capacity were more likely to be classified as PrEP aware compared to prescribers (ps < 0.05). PrEP-naïve providers could benefit from continuing education, whereas PrEP-aware providers might benefit from capacity building and prescribing optimization interventions.
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21
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Sales JM, Escoffery C, Hussen SA, Haddad LB, McCumber M, Kwiatkowski E, Filipowicz T, Sanchez M, Psioda MA, Sheth AN. Pre-exposure Prophylaxis Implementation in Family Planning Services Across the Southern United States: Findings from a Survey Among Staff, Providers and Administrators Working in Title X-Funded Clinics. AIDS Behav 2021; 25:1901-1912. [PMID: 33483899 DOI: 10.1007/s10461-020-03120-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/13/2023]
Abstract
To improve women's access to pre-exposure prophylaxis (PrEP) in family planning (FP) clinics, we examined readiness to provide PrEP, and barriers and facilitators at the clinic level to integrate PrEP services into Title X-funded FP clinics across the Southern US. Title X-funded FP clinics across DHHS regions III (Mid-Atlantic), IV (Southeast), and VI (Southwest), comprising the Southern US. From February to June, 2018, we conducted a web-based, geographically targeted survey of medical staff, providers and administrators of Title X-funded FP clinics in DHHS regions III (Mid-Atlantic), IV (Southeast), and VI (Southwest). Survey items were developed using the Consolidated Framework for Implementation Research to assess constructs relevant to PrEP implementation. One-fifth of 283 unique Title X clinics across the South provided PrEP. Readiness for PrEP implementation was positively associated with a climate supportive of HIV prevention, leadership engagement, and availability of resources, and negatively associated with providers holding negative attitudes about PrEP's suitability for FP. The Title X FP network is a vital source of sexual health care for millions of individuals across the US. Clinic-level barriers to providing PrEP must be addressed to expand onsite PrEP delivery in Title X FP clinics in the Southern US.
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Affiliation(s)
- Jessica M Sales
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Cam Escoffery
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophia A Hussen
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa B Haddad
- Division of Family Planning, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Micah McCumber
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Evan Kwiatkowski
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Teresa Filipowicz
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Sanchez
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew A Psioda
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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22
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Physician Assistant's Knowledge and Confidence Regarding Prescribing Preexposure Prophylaxis for HIV Prevention. Sex Transm Dis 2021; 47:530-534. [PMID: 32404857 DOI: 10.1097/olq.0000000000001196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Physician assistants (PAs) have an important role to play in increasing preexposure prophylaxis (PrEP) prescriptions. We surveyed PAs regarding knowledge of Centers for Disease Control and Prevention guidelines for PrEP and confidence regarding PrEP. Physician assistants in primary care reported more accurate knowledge and higher confidence. However, knowledge and confidence gaps were present among all PAs, regardless of specialty.
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23
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Determining the level of sexually transmitted diseases (STDs) awareness in Ota, Nigeria. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Przybyla S, Fillo J, Kamper-DeMarco K, Bleasdale J, Parks K, Klasko-Foster L, Morse D. HIV pre-exposure prophylaxis (PrEP) knowledge, familiarity, and attitudes among United States healthcare professional students: A cross-sectional study. Prev Med Rep 2021; 22:101334. [PMID: 33680721 PMCID: PMC7930580 DOI: 10.1016/j.pmedr.2021.101334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/24/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
The United States' initiative to End the HIV Epidemic by 2030 includes a primary goal to reduce new HIV infections by 90 percent. One key contributor to this plan is HIV pre-exposure prophylaxis (PrEP). While knowledge and acceptance of PrEP among clinicians is growing, few studies have assessed knowledge and awareness among future healthcare professionals in academic training programs. The present study aimed to assess and compare healthcare trainees' awareness, knowledge, and familiarity with PrEP prescribing guidelines to better understand and prevent gaps in academic training regarding PrEP. A cross-sectional web-based survey of medical, nurse practitioner, and pharmacy students enrolled at two universities was conducted between October 2017 and January 2018. The study assessed participants' awareness, knowledge, and familiarity with PrEP prescribing guidelines and willingness to prescribe PrEP and refer to another healthcare provider. The survey was completed by 744 participants (response rate = 36.2%). Overall, PrEP awareness was high though PrEP knowledge was low. There were significant differences among student groups in domains of interest. Pharmacy students had the greatest PrEP knowledge, awareness, and familiarity with prescribing guidelines. However, medical students reported the greatest comfort with performing PrEP-related clinical activities and willingness to refer a candidate to another provider. Study findings enhance our understanding of healthcare professional students' perspectives of PrEP as a biomedical prevention strategy for HIV. The gaps in students' knowledge offer opportunities for the development of educational strategies to support HIV prevention among future healthcare professionals.
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Affiliation(s)
- Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Corresponding author at: Director of Undergraduate Public Health Programs, University at Buffalo School of Public Health and Health Professions, 3435 Main Street, 305 Kimball Tower, United States.
| | - Jennifer Fillo
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, United States
| | | | - Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Kathleen Parks
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Lynne Klasko-Foster
- Department of Psychology and Human Behavior, William Alpert Medical School, Brown University, Providence, RI, United States
- Center for Health Equity Research, School of Public Health, Brown University, Providence, RI, United States
| | - Diane Morse
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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Agovi AMA, Anikpo I, Cvitanovich MJ, Craten KJ, Asuelime EO, Ojha RP. Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system. Prev Med Rep 2020; 20:101266. [PMID: 33364148 PMCID: PMC7750167 DOI: 10.1016/j.pmedr.2020.101266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
Safety-net health systems are a primary source of care for socioeconomically disadvantaged individuals who may be eligible for HIV pre-exposure prophylaxis (PrEP) and are priority groups under the Ending the HIV Epidemic (EHE) initiative. Nevertheless, little evidence is available about barriers to PrEP implementation in safety-net settings. We aimed to assess the association between PrEP knowledge and prescribing practices, and to ascertain unmet knowledge needs to implement PrEP. In 2019, we surveyed primary care providers (PCPs) in a safety-net health system that serves an EHE priority jurisdiction located in North Texas. Our questionnaire ascertained self-reported prescribing practices, knowledge, and training needs related to PrEP. We used penalized logistic regression to estimate odds ratio (OR) and 95% posterior limits (PL) for the association between provider self-rated knowledge of PrEP and PrEP prescribing. Our study population comprised 62 primary care providers, of whom 61% were female, 60% were non-Hispanic White, 76% were physicians (76%), 57% had ≥ 10 years of practice experience, 45% reported low self-rated PrEP knowledge, and 35% prescribed PrEP in the past year. Providers with low PrEP knowledge had 69% lower odds of prescribing PrEP within the past year (OR = 0.31, 95% PL: 0.12, 0.82). Eligibility for PrEP, side effects and adherence concerns were key unmet knowledge needs. Our findings suggest that low provider PrEP knowledge may be a barrier to PrEP prescribing among safety-net PCPs. Our results provide insight about specific educational needs of PCPs in a safety-net health system, which are amenable to educational intervention.
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Affiliation(s)
- Afiba Manza-A. Agovi
- Center for Outcomes Research, JPS Health Network, Fort Worth, TX, United States
- Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, TX, United States
- Corresponding author at: Center for Outcomes Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX 76104, United States.
| | - Ifedioranma Anikpo
- Center for Outcomes Research, JPS Health Network, Fort Worth, TX, United States
| | | | - Kevin J. Craten
- Center for Outcomes Research, JPS Health Network, Fort Worth, TX, United States
| | - Eve O. Asuelime
- Healing Wings-Infectious Disease Clinic, JPS Health Network, Fort Worth, TX, United States
| | - Rohit P. Ojha
- Center for Outcomes Research, JPS Health Network, Fort Worth, TX, United States
- Department of Medical Education, TCU and UNTHSC School of Medicine, Fort Worth, TX, United States
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John SA, Quinn KG, Pleuhs B, Walsh JL, Petroll AE. HIV Post-Exposure Prophylaxis (PEP) Awareness and Non-Occupational PEP (nPEP) Prescribing History Among U.S. Healthcare Providers. AIDS Behav 2020; 24:3124-3131. [PMID: 32300991 PMCID: PMC7508835 DOI: 10.1007/s10461-020-02866-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Non-occupational post-exposure prophylaxis (nPEP) has been clinically recommended since 2005. HIV providers and non-HIV providers (n = 480) practicing within above-average HIV prevalence ZIP codes of the 10 U.S. cities with greatest overall HIV prevalence participated in a cross-sectional survey between July 2014 and May 2015. Providers were asked about their awareness of post-exposure prophylaxis (PEP) and nPEP prescribing experience for patients with potential sexual exposures to HIV, which we coded into a PEP prescribing cascade with three categories: (1) PEP unaware, (2) PEP aware, no nPEP prescribing experience, and (3) nPEP prescribing experience. Overall, 12.5% were unaware of PEP, 43.5% were aware but hadn't prescribed nPEP, and 44.0% had prescribed nPEP for potential sexual exposures to HIV. Fewer providers practicing in the U.S. South had ever prescribed nPEP compared to providers in other regions (χ2= 39.91, p < 0.001). HIV providers, compared to non-HIV providers, were more likely to be classified in the nPEP prescription group compared to the PEP aware without nPEP prescription group (RRR = 2.96, p < 0.001). PrEP prescribers, compared to those PrEP unaware, were more likely to be classified in the nPEP prescription group compared to PEP aware without nPEP prescription group (RRR = 12.49, p < 0.001).
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Affiliation(s)
- Steven A John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA.
| | - Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Benedikt Pleuhs
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
| | - Andrew E Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI, 53202, USA
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Bunting SR, Garber SS, Goldstein RH, Ritchie TD, Batteson TJ, Keyes TJ. Student Education About Pre-exposure Prophylaxis (PrEP) Varies Between Regions of the United States. J Gen Intern Med 2020; 35:2873-2881. [PMID: 32080792 PMCID: PMC7573046 DOI: 10.1007/s11606-020-05736-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Daily, oral pre-exposure prophylaxis (PrEP) is an effective and safe prevention strategy for people at risk for HIV. However, prescription of PrEP has been limited for patients at the highest risk. Disparities in PrEP prescription are pronounced among racial and gender minority patients. A significant body of literature indicates that practicing healthcare providers have little awareness and knowledge of PrEP. Very little work has investigated the education about PrEP among health professionals in training. OBJECTIVE The objective of this study was to compare health professions students' awareness of PrEP and education about PrEP between regions of the US, and to determine if correlations between regional HIV incidence and PrEP use were present. DESIGN Survey study. PARTICIPANTS A cross-sectional sample of health professions students (N = 1859) representing future prescribers (MD, DO, PA), pharmacists, and nurses in the US. KEY RESULTS Overall, 83.4% of students were aware of PrEP, but only 62.2% of fourth-year students indicated they had been taught about PrEP at any time during their training. Education about PrEP was most comprehensive in the Northeastern US, the area with the highest PrEP to need ratio (4.7). In all regions, transgender patients and heterosexual men and women were least likely to be presented in education as PrEP candidates, and men who have sex with men were the most frequently presented. CONCLUSIONS There are marked differences in education regarding PrEP both between academic programs and regions of the USA.
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Affiliation(s)
- Samuel R Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
| | - Sarah S Garber
- Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Robert H Goldstein
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Tamzin J Batteson
- DeWitt C. Baldwin Institute for Interprofessional Education, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Johnson TM, Klepser DG, Bares SH, Scarsi KK. Predictors of vaccination rates in people living with HIV followed at a specialty care clinic. Hum Vaccin Immunother 2020; 17:791-796. [PMID: 32881642 DOI: 10.1080/21645515.2020.1802163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
People Living with HIV (PLWH) remain disproportionately susceptible to vaccine-preventable illnesses due to increased morbidity and mortality from common pathogens, increased transmission related to epidemiologic factors, and decreased vaccination rates. We aimed to describe patient-specific predictive factors that may impact adherence to the CDC's recommended vaccination schedules in PLWH. We retrospectively evaluated adult PLWH in care at the University of Nebraska Medical Center's HIV clinic and collected information related to demographics, clinic visits, vaccination status, and measures of HIV disease control. Patients were categorized as "Adherent" if they had received all vaccinations for which they were eligible and were categorized as "Non-Adherent" if they were deficient or delayed in receiving one or more vaccinations. Participant characteristics were compared between groups by multivariable logistic regression to identify predictors associated with vaccine schedule non-adherence. We evaluated 502 PLWH who met our inclusion criteria; 206 of these (41%) had received all eligible vaccinations, while 296 (59%) were missing one or more vaccinations. The mean age of participants was 48 years old, 76% were male, and 53% were white. Our participants had a median of 2.83 clinic visits per year and missed 8.3% of scheduled clinic visits. Factors associated with non-adherence to vaccination schedules included a high frequency of missed clinic appointments (>10%), men who have sex with men, and a CD4 count <200 cells/mm3. Knowledge of variables associated with vaccination rates may be beneficial in identifying patients at-risk for under-vaccination and designing targeted education programs for providers and patients.
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Affiliation(s)
- Tanner M Johnson
- College of Pharmacy, Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pharmacy, UCHealth University of Colorado Hospital, Aurora, CO, USA.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Donald G Klepser
- College of Pharmacy, Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sara H Bares
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kimberly K Scarsi
- College of Pharmacy, Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE, USA.,Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Picard J, Jacka B, Høj S, Laverdière É, Cox J, Roy É, Bruneau J. Real-World Eligibility for HIV Pre-exposure Prophylaxis Among People Who Inject Drugs. AIDS Behav 2020; 24:2400-2408. [PMID: 31997057 PMCID: PMC10710293 DOI: 10.1007/s10461-020-02800-w] [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: 10/25/2022]
Abstract
Recent studies have highlighted the efficacy of and willingness to use pre-exposure prophylaxis (PrEP) to prevent HIV infection among people who inject drugs (PWID), however knowledge of real-world applicability is limited. We aimed to quantify the real-world eligibility for HIV-PrEP among HIV-negative PWID in Montreal, Canada (n = 718). Eligibility was calculated according to US Centers for Disease Control and Prevention (CDC) guidelines and compared to risk of HIV acquisition according to the assessing the risk of contracting HIV (ARCH-IDU) risk screening tool. Over one-third of participants (37%) were eligible for HIV PrEP, with 1/3 of these eligible due to sexual risk alone. Half of participants were considered high risk of HIV acquisition according to ARCH-IDU, but there was poor agreement between the two measures. Although a large proportion of PWID were eligible for HIV-PrEP, better tools that are context- and location-informed are needed to identify PWID at higher risk of HIV acquisition.
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Affiliation(s)
- Jonathan Picard
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Brendan Jacka
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Stine Høj
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Émélie Laverdière
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Regional Public Health Department, CIUSSS du Centre-Sud-de-L'Ile-de-Montréal, Montréal, Canada
| | - Élise Roy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
- Direction des risques biologiques et de sa santé au travail, Institut National de Santé Publique du Québec, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada.
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada.
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Furukawa NW, Maksut JL, Zlotorzynska M, Sanchez TH, Smith DK, Baral SD. Sexuality Disclosure in U.S. Gay, Bisexual, and Other Men Who Have Sex With Men: Impact on Healthcare-Related Stigmas and HIV Pre-Exposure Prophylaxis Denial. Am J Prev Med 2020; 59:e79-e87. [PMID: 32376144 PMCID: PMC7375915 DOI: 10.1016/j.amepre.2020.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Stigma impairs access to health care by gay, bisexual, and other men who have sex with men. Gay, bisexual, and other men who have sex with men who are open about their sexuality, or out, are more resilient to stigma than those who are not out. Outness may influence healthcare utilization and prescription of HIV pre-exposure prophylaxis to HIV-negative gay, bisexual, and other men who have sex with men. METHODS Analyzing the 2018 American Men's Internet Survey during 2019, the adjusted prevalence ratios of healthcare stigmas and outness to healthcare providers were calculated. The effect of outness on annual healthcare visits and stigma was measured. Pre-exposure prophylaxis seeking and denial by providers was quantified and stratified by outness. RESULTS Of 5,794 respondents, 3,402 (58.7%) were out to their provider. Out gay, bisexual, and other men who have sex with men were less likely to experience anticipated stigma (adjusted prevalence ratio=0.75, 95% CI=0.72, 0.80) but more likely to experience enacted stigma or discrimination (adjusted prevalence ratio=1.23, 95% CI=1.18, 1.28). In a subsample of out gay, bisexual, and other men who have sex with men, recently experienced discrimination was associated with higher healthcare utilization (adjusted prevalence ratio=1.51, 95% CI=1.14, 1.51). Conversely, recent experienced discrimination was associated with lower healthcare utilization in not out gay, bisexual, and other men who have sex with men (adjusted prevalence ratio=0.67, 95% CI=0.54, 0.82). Of 3,104 out gay, bisexual, and other men who have sex with men, 1,417 (45.7%) discussed pre-exposure prophylaxis with their providers, compared with 120 of 1,711 (7.0%) gay, bisexual, and other men who have sex with men who were not out (p<0.001). Pre-exposure prophylaxis denials were less common among out (116/793, 14.6%) than not out (14/55, 25.5%) gay, bisexual, and other men who have sex with men (p=0.044). CONCLUSIONS Healthcare provider-related stigmas impair healthcare engagement among not out gay, bisexual, and other men who have sex with men who were also more commonly denied pre-exposure prophylaxis. Ending the HIV epidemic necessitates creating safe environments for disclosure of sexual preferences and practices to facilitate access to HIV prevention.
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Affiliation(s)
- Nathan W Furukawa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Jessica L Maksut
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Zlotorzynska
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Travis H Sanchez
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Dawn K Smith
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Carter MR, Aaron E, Nassau T, Brady KA. Knowledge, Attitudes, and PrEP Prescribing Practices of Health Care Providers in Philadelphia, PA. J Prim Care Community Health 2020; 10:2150132719878526. [PMID: 31578913 PMCID: PMC6777052 DOI: 10.1177/2150132719878526] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Preexposure prophylaxis (PrEP) is an effective
biomedical intervention that has the potential to dramatically decrease the
incidence of HIV but remains an underutilized method of HIV prevention. The
Philadelphia Department of Public Health administered an online survey to health
care providers in the Philadelphia area with the aim of characterizing PrEP
attitudes, knowledge, and prescribing practices. Methods: Online
surveys were distributed to 1000 providers who were recruited through
distribution lists of Philadelphia medical providers between September and
December 2017. A Likert-type response scale was utilized to analyze participant
self-reported responses. Participant practice settings included HIV/ID, family
and internal medicine, women’s health, and pediatric/adolescent clinics.
Results and Discussion: The response rate of the survey was 9%.
Of 81 complete responses, 75% (N = 61) felt comfortable providing PrEP and 77%
(N = 62) had ever written a PrEP prescription. Compared with primary care
providers, HIV care providers were significantly more knowledgeable about
required laboratory testing for prescribing PrEP (P = .03) and
were more likely to have prescribed PrEP to more than 10 patients
(P = .006). Women’s health and pediatric providers reported
feeling less comfortable providing PrEP to their patients (P =
.0003). Conclusion: The majority of health care providers in the
Philadelphia area who responded to the survey reported experience with providing
PrEP to their patients. In the present study, HIV care providers were
significantly more comfortable and knowledgeable about prescribing PrEP compared
with providers in primary care, women’s health, and/or adolescent/pediatric
medicine. Results were limited by sampling bias, as providers who responded to
the survey may have prior experience with PrEP. Future Health Department
educational trainings need to target primary and preventive care providers,
providers who have never prescribed PrEP, and providers who see few patients
living with HIV.
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Affiliation(s)
- Margaret R Carter
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Erika Aaron
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Tanner Nassau
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Kathleen A Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA, USA
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Health Care Provider Perspectives on Pre-exposure Prophylaxis: A Qualitative Study. J Assoc Nurses AIDS Care 2020; 30:630-638. [PMID: 30958406 DOI: 10.1097/jnc.0000000000000073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although pre-exposure prophylaxis (PrEP) requires a prescription from a health care provider, we lack unanimity in guidelines for the identification of the ideal provider type to prescribe PrEP. The purpose of our study was to understand clinician perspectives on provider categories to determine who is best suited to prescribe this medication to HIV-uninfected patients. We conducted 28 in-depth interviews between September 2017 and January 2018 with current prescribers of PrEP. Qualitative findings indicated that providers were split on recommended PrEP prescriber type. Five themes emerged that centered on the explicit identification of the issue of opportunity for providers to educate their patients on PrEP and offer this medication to at-risk populations. To effectively maximize presentation for care and subsequently amplify uptake of PrEP, growing the base of providers who offer PrEP to eligible patients can provide a meaningful public health impact on reducing HIV incidence.
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Mayer KH, Agwu A, Malebranche D. Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review. Adv Ther 2020; 37:1778-1811. [PMID: 32232664 PMCID: PMC7467490 DOI: 10.1007/s12325-020-01295-0] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Indexed: 01/01/2023]
Abstract
Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute and Harvard Medical School, Boston, MA, USA.
| | - Allison Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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HIV Seroconversion in the Era of Pharmacologic Prevention: A Case-Control Study at a San Francisco STD Clinic. J Acquir Immune Defic Syndr 2020; 82:159-165. [PMID: 31192823 DOI: 10.1097/qai.0000000000002107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The comparative effectiveness of pre- and post-exposure prophylaxis (PrEP and PEP) for men who have sex with men (MSM) is unclear. SETTING We conducted a case-control study of MSM who were initially HIV-uninfected during September 1, 2012-June 30, 2016 at San Francisco's only municipal sexually transmitted diseases (STDs) clinic. METHODS Each case was matched with up to 3 controls based on age, baseline visit date, and follow-up time. The primary dependent variable was HIV seroconversion; the primary independent variable was exposure to PrEP, PEP, or neither. Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS Of 638 MSM (161 cases and 477 controls), 137 reported ever taking PrEP, 98 reported taking PEP-only, and 403 took neither. PrEP takers had more non-HIV sexually transmitted diseases during the analysis (72.3% vs. 55.1% vs. 42.4% P < 0.01) and were more likely to report receptive anal sex in the past 3 months (86.5% vs. 80.4% vs. 73.0%; P < 0.01). In the adjusted model, PrEP was associated with lower odds of HIV seroconversion (odds ratio 0.24; 95% confidence interval: 0.13 to 0.46) while PEP use had no effect on HIV acquisition compared with taking neither. CONCLUSIONS MSM who ever used PrEP demonstrated equal or higher sexual risk compared with those using neither PrEP nor PEP but had 76% lower odds of HIV seroconversion. MSM who used PEP but never PrEP were no less likely to seroconvert than those using neither. MSM should be offered PrEP. PEP users with ongoing risk of HIV infection should be connected to PrEP after PEP.
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Pleuhs B, Quinn KG, Walsh JL, Petroll AE, John SA. Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review. AIDS Patient Care STDS 2020; 34:111-123. [PMID: 32109141 DOI: 10.1089/apc.2019.0189] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Increasing prescription of pre-exposure prophylaxis (PrEP) is imperative to ending the HIV epidemic in the United States. The objective of this review was to identify health care provider barriers to PrEP implementation. A systematic review was conducted in February 2019 using PubMed to identify barriers to PrEP prescribing practices in the United States. Targeted search terms surrounding PrEP and providers resulted in 222 original studies, 28 of which were ultimately included in our review, with data collected between 2011 and 2018. Six themes were identified across reviewed studies: (i) a lack of PrEP knowledge, (ii) the presence of the Purview Paradox, which refers to discordance in beliefs between HIV specialists and primary care providers on who should prescribe PrEP, (iii) concerns about PrEP costs, (iv) concerns about behavioral and health consequences, (v) interpersonal stigma, and (vi) concerns about patient adherence. A majority of providers were lacking knowledge regarding PrEP, resulting in discomfort in prescribing PrEP, or limited awareness and understanding of PrEP clinical guidelines. Discrepant opinions were identified regarding whether PrEP was best managed within primary care or specialty clinics. Other barriers included concerns about cost, patient adherence, and follow-up maintenance care. Finally, concerns about risk compensation and discomfort discussing sexual activities with patients who would benefit most from PrEP were apparent. Additional work is needed to prepare providers to prescribe and manage patients on PrEP, optimize PrEP delivery, and reduce provider bias. Future research is needed to identify providers' attitudes and beliefs regarding innovations in PrEP dosing, task shifting, and novel strategies for PrEP care.
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Affiliation(s)
- Benedikt Pleuhs
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katherine G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer L. Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew E. Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steven A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin
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Owens C, Hubach RD, Williams D, Lester J, Reece M, Dodge B. Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:51-66. [PMID: 32073310 DOI: 10.1521/aeap.2020.32.1.51] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most pre-exposure prophylaxis (PrEP) research samples men who have sex with men (MSM) who live in metropolitan cities. There is a limited understanding of the PrEP experiences among rural MSM. Thirty-four semi-structured interviews were conducted to explore the PrEP health care experiences among 34 rural Midwestern MSM. Of the 34 participants, 23 obtained PrEP from their non-primary care provider (PCP). Three themes were present: (1) PrEP is unavailable in rural areas, (2) PrEP is inaccessible in rural areas due to PCPs being unwilling to prescribe PrEP, and (3) PrEP services are unamicable in rural areas due to stigmatizing attitudes and behaviors of PCPs. It is important to address PrEP care continuum factors in all settings; however, these factors are often exacerbated in rural areas due to social determinants. Without further research and programming, organizational and social determinants may contribute to lower rates of PrEP outcomes in rural areas.
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Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, Oklahoma
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - Jessica Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, Indiana
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio State University, Athens, Ohio
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
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Pyra M, Rusie LK, Baker KK, Baker A, Ridgway J, Schneider J. Correlations of HIV Preexposure Prophylaxis Indications and Uptake, Chicago, Illinois, 2015-2018. Am J Public Health 2020; 110:370-377. [PMID: 31944849 DOI: 10.2105/ajph.2019.305469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine gaps in identification of preexposure prophylaxis (PrEP) candidates, uptake, and use of PrEP by populations most likely to seroconvert.Methods. At a federally qualified health center in Chicago, Illinois, we used electronic medical records, prescription data, and our best approximation of Centers for Disease Control and Prevention PrEP guidelines to determine how many patients were indicated for PrEP relative to HIV diagnoses (indication:HIV), how many were on PrEP relative to indications (PrEP:indication), and how many were on PrEP relative to HIV diagnoses (PrEP:HIV). We compared these ratios across age, gender and orientation, race/ethnicity, and insurance.Results. Overall, there were 32 indications per incident diagnosis and 16 patients on PrEP per incident diagnosis. In adjusted models, Whites had higher indication:HIV and PrEP:HIV ratios compared with Blacks, men who have sex with men had higher indication:HIV and PrEP:HIV ratios compared with transwomen but lower PrEP:indication ratios, and uninsured patients had higher indication:HIV but lower PrEP:indication and PrEP:HIV ratios compared with those with insurance.Conclusions. PrEP use, relative to HIV diagnoses, differs by important patient characteristics. While improved guidelines will address some of the disparity, better approaches for determining PrEP candidates and more normalized patient-provider communication are needed to ensure better PrEP access to all individuals at high risk for HIV.
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Affiliation(s)
- Maria Pyra
- Maria Pyra, Laura K. Rusie, Kristin Keglovitz Baker, Andie Baker, and John Schneider are with Howard Brown Health, Chicago, IL. Jessica Ridgway is with the Chicago Center for HIV Elimination, University of Chicago, Chicago
| | - Laura K Rusie
- Maria Pyra, Laura K. Rusie, Kristin Keglovitz Baker, Andie Baker, and John Schneider are with Howard Brown Health, Chicago, IL. Jessica Ridgway is with the Chicago Center for HIV Elimination, University of Chicago, Chicago
| | - Kristin Keglovitz Baker
- Maria Pyra, Laura K. Rusie, Kristin Keglovitz Baker, Andie Baker, and John Schneider are with Howard Brown Health, Chicago, IL. Jessica Ridgway is with the Chicago Center for HIV Elimination, University of Chicago, Chicago
| | - Andie Baker
- Maria Pyra, Laura K. Rusie, Kristin Keglovitz Baker, Andie Baker, and John Schneider are with Howard Brown Health, Chicago, IL. Jessica Ridgway is with the Chicago Center for HIV Elimination, University of Chicago, Chicago
| | - Jessica Ridgway
- Maria Pyra, Laura K. Rusie, Kristin Keglovitz Baker, Andie Baker, and John Schneider are with Howard Brown Health, Chicago, IL. Jessica Ridgway is with the Chicago Center for HIV Elimination, University of Chicago, Chicago
| | - John Schneider
- Maria Pyra, Laura K. Rusie, Kristin Keglovitz Baker, Andie Baker, and John Schneider are with Howard Brown Health, Chicago, IL. Jessica Ridgway is with the Chicago Center for HIV Elimination, University of Chicago, Chicago
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Bleasdale J, Wilson K, Aidoo-Frimpong G, Przybyla S. Prescribing HIV pre-exposure prophylaxis: A qualitative analysis of health care provider training needs. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2020; 19:107-123. [PMID: 32908464 PMCID: PMC7478340 DOI: 10.1080/15381501.2020.1712291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Increasing the number of pre-exposure prophylaxis (PrEP) prescriptions will require more health care providers to be willing and trained to prescribe the medication. The purpose of our study was to understand the training needs of clinicians who do not prescribe PrEP. From September 2017 to January 2018, qualitative interviews were conducted with providers who had no experience prescribing PrEP (N = 20). Thematic analysis revealed four themes: three emphasized the temporal nature of training requirements and one identified training preferences of providers. Study findings suggest that clinicians require specific information in order to integrate PrEP into their practices successfully.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Kennethea Wilson
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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Abstract
PURPOSE OF REVIEW This review summarizes novel interventions that employ technology to improve HIV pre-exposure prophylaxis (PrEP) availability, uptake, and adherence. RECENT FINDINGS Several notable technology-based programs are increasing access to PrEP in unique ways. We identified multiple models for using telehealth to bolster PrEP dissemination and adherence, such as mobile applications that offer PrEP prescribing without an in-person visit, longitudinal distance telementoring for community provider PrEP education and clinical guidance, and electronic consults for PrEP specialist support in the primary care setting. Outcomes data for all of these modalities are limited but show promise. Technology-based interventions can address gaps in the PrEP care continuum. Future research should assess and compare outcomes, scalability, cost-effectiveness, and sustainability. Costs associated with the creation of new technological tools slow innovation and the field would benefit from a platform for technology sharing.
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Zhang C, McMahon J, Fiscella K, Przybyla S, Braksmajer A, LeBlanc N, Liu Y. HIV Pre-Exposure Prophylaxis Implementation Cascade Among Health Care Professionals in the United States: Implications from a Systematic Review and Meta-Analysis. AIDS Patient Care STDS 2019; 33:507-527. [PMID: 31821044 DOI: 10.1089/apc.2019.0119] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although pre-exposure prophylaxis (PrEP) has been approved for primary HIV prevention for individuals aged 18 years or older since 2012, PrEP utilization has been suboptimal. To understand trends in PrEP provision from the health care providers' perspective, we systematically assessed each specific stage along the PrEP implementation cascade (i.e., awareness, willingness, consultation, and prescription) among health care professionals (HCPs) in the United States. Between June and December 2018, we conducted a systematic review of published studies on this topic. A total of 36 eligible studies were identified and included in the analyses. Random-effect models were employed to examine the pooled prevalence of each key stage along the cascade. Time trend and subgroup analyses were conducted. A thematic analysis was used to identify barriers and facilitators along the PrEP cascade. In this study, a total of 18,265 HCPs representing diverse demographics were included. The pooled prevalence of PrEP awareness was 68% [95% confidence interval (CI) = 55-80%], willingness to prescribe PrEP was 66% (95% CI = 54-77%), PrEP consultation was 37% (95% CI = 25-51%), and prescription provision was 24% (95% CI = 17-32%). Subgroup analyses revealed that PrEP provision among HCPs was lowest in the south, but has been improving annually nationwide. Infectious disease specialists [odds ratio (OR) = 4.06, 95% CI = 3.12-5.28; compared with primary care providers] and advanced practice registered nurses/physician assistants (OR = 1.51, 95% CI = 1.09-2.09; compared with physicians) had higher odds of prescribing PrEP. Barriers and facilitators regarding optimal PrEP implementation were embedded within individual, dyadic, social, and structural levels. This meta-analysis has comprehensively examined the trend and pattern of PrEP implementation among HCPs. To achieve optimal implementation of the PrEP cascade in the United States, tailored training and programs need to be provided to HCPs.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York
| | - Amy Braksmajer
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Natalie LeBlanc
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Yu Liu
- Division of Epidemiology, Department of Public Health Science, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
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Wood BR, Mann MS, Martinez-Paz N, Unruh KT, Annese M, Spach DH, Scott JD, Stekler JD. Project ECHO: telementoring to educate and support prescribing of HIV pre-exposure prophylaxis by community medical providers. Sex Health 2019; 15:601-605. [PMID: 30318034 DOI: 10.1071/sh18062] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/30/2018] [Indexed: 11/23/2022]
Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective tool to prevent HIV infection for at-risk individuals, but access requires medical providers to be aware of and comfortable with prescribing PrEP. Project ECHO (Extension for Community Healthcare Outcomes) was started to support hepatitis C virus treatment in rural New Mexico, but has since expanded to train health practitioners to treat other medical conditions in other locations. METHODS In 2012, a Project ECHO telehealth program was launched to mentor community HIV practitioners in our region. In July 2015, quarterly PrEP didactics and monthly PrEP case discussions were incorporated into this program. The result was a pilot PrEP telementoring intervention. An initial nine-question survey assessed baseline community practitioner knowledge and attitudes towards PrEP, and a follow-up 16-item survey 2 years later assessed the effect of Project ECHO on PrEP knowledge, concerns and prescribing practices. RESULTS Twenty-four and 45 medical providers completed the baseline and follow-up surveys respectively. In follow-up, providers reported that Project ECHO participation helped them stay current on PrEP guidelines, improved knowledge, increased likelihood to prescribe PrEP and addressed most concerns about prescribing PrEP. One exception was continued concerns about cost and insurance access, which were addressed by adjusting the didactic curriculum. Many participants reported that the Project ECHO pilot PrEP telementoring intervention assisted them in disseminating PrEP knowledge to other medical providers in their region. CONCLUSIONS It is feasible to incorporate PrEP training into Project ECHO distance telementoring programs as a tool to educate community practitioners and support PrEP prescribing.
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Affiliation(s)
- Brian R Wood
- University of Washington Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Maren S Mann
- University of Washington School of Nursing, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Natalia Martinez-Paz
- Mountain West AIDS Education and Training Center (MW AETC), 325 9th Avenue, Seattle, WA 98104, USA
| | - Kenton T Unruh
- Mountain West AIDS Education and Training Center (MW AETC), 325 9th Avenue, Seattle, WA 98104, USA
| | - Mary Annese
- Mountain West AIDS Education and Training Center (MW AETC), 325 9th Avenue, Seattle, WA 98104, USA
| | - David H Spach
- University of Washington Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - John D Scott
- University of Washington Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Joanne D Stekler
- University of Washington Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Seattle, WA 98195, USA
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Comfort Discussing HIV Pre-exposure Prophylaxis With Patients Among Physicians in an Urban Emergency Department. J Acquir Immune Defic Syndr 2019; 80:e49-e52. [PMID: 30422901 DOI: 10.1097/qai.0000000000001890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Pyra MN, Haberer JE, Hasen N, Reed J, Mugo NR, Baeten JM. Global implementation of PrEP for HIV prevention: setting expectations for impact. J Int AIDS Soc 2019; 22:e25370. [PMID: 31456348 PMCID: PMC6712462 DOI: 10.1002/jia2.25370] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/09/2019] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Questions remain whether HIV pre-exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population-level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence, and persistence and their combined impact on the epidemic. DISCUSSION Targets for PrEP uptake must be based on the local HIV epidemic and will depend on appropriate estimates of the key populations at risk for HIV. However, there is evidence that targets, once established, can successfully be met and that uptake may increase with awareness. Messaging around adherence should include that daily adherence is the goal (except for those MSM for whom event-driven dosing is a good fit), but perfect adherence should not be a barrier. Ideally, clients persist on PrEP for as long as they are at risk for HIV. While PrEP will be most effective when coverage is focused on high-risk populations, normalizing rather than stigmatizing PrEP will be highly beneficial. CONCLUSIONS While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.
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Affiliation(s)
- Maria N Pyra
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Jessica E Haberer
- Massachusetts General Hospital Global HealthBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | | | | | - Nelly R Mugo
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Kenya Medical Research Institute (KEMRI)NairobiKenya
| | - Jared M Baeten
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
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Martínez Sanz J, Pérez Elías MJ, Muriel A, Gómez Ayerbe C, Vivancos Gallego MJ, Sánchez Conde M, Herrero Delgado M, Pérez Elías P, Polo Benito L, de la Fuente Cortés Y, Barea R, Sullivan AK, Fuster Ruiz de Apodaca MJ, Galindo MJ, Moreno S. Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates. PLoS One 2019; 14:e0218380. [PMID: 31265464 PMCID: PMC6605851 DOI: 10.1371/journal.pone.0218380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed. Methods A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer. Results A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01–1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77–0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17–0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01–5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04–2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02–1.42; p = 0.036). Conclusions This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.
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Affiliation(s)
- Javier Martínez Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Jesús Pérez Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- * E-mail: ,
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Gómez Ayerbe
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Matilde Sánchez Conde
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | | | | | | | - Ann K. Sullivan
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, United Kingdom
| | | | - María José Galindo
- Infectious Diseases Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Powell VE, Gibas KM, DuBow J, Krakower DS. Update on HIV Preexposure Prophylaxis: Effectiveness, Drug Resistance, and Risk Compensation. Curr Infect Dis Rep 2019; 21:28. [PMID: 31227999 DOI: 10.1007/s11908-019-0685-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW In 2019, the US government launched an initiative to decrease new HIV infections by 90% over the next decade. Studies have demonstrated the efficacy of HIV preexposure prophylaxis (PrEP) for high-risk populations, and the United States Preventative Services Task Force has issued a grade A recommendation for PrEP, indicating substantial net benefit. However, questions have been raised about the effectiveness of PrEP in clinical settings and whether PrEP use might promote antiretroviral drug resistance and increased sexual risk behaviors, which could increase transmission of bacterial sexually transmitted infections. In this narrative review, we summarize recent evidence of the effectiveness of PrEP when provided in clinical and community settings, the emergence of antiretroviral drug resistance during PrEP use, and associations between PrEP use and increased sexual risk behaviors. We also review novel PrEP modalities that are being developed to optimize PrEP acceptability, adherence, and effectiveness. RECENT FINDINGS Studies suggest that PrEP is effective when provided in clinical settings. However, PrEP uptake and impact have been limited in the USA thus far, and major disparities in access to PrEP exist. In addition, there is evidence that drug resistance can occur with PrEP use, particularly with inadvertent PrEP use during undiagnosed acute HIV infection. Risk compensation can also occur with PrEP use and has been associated with increased sexually transmitted infections. Promising new modalities for PrEP could expand options. PrEP has strong potential to decrease HIV incidence. However, disparities in access must be addressed to ensure equity and impact for PrEP. While drug resistance and risk compensation can occur with PrEP use, these are not valid reasons to withhold PrEP from patients given its substantial protective benefits.
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Affiliation(s)
- Victoria E Powell
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA
| | - Kevin M Gibas
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA
| | - Joshua DuBow
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA. .,Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
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PrEParing Providers: The Next Challenge in Implementing Human Immunodeficiency Virus Preexposure Prophylaxis. Sex Transm Dis 2019; 45:459-461. [PMID: 29889161 DOI: 10.1097/olq.0000000000000835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O'Byrne P, MacPherson P, Orser L, Jacob JD, Holmes D. PrEP-RN: Clinical Considerations and Protocols for Nurse-Led PrEP. J Assoc Nurses AIDS Care 2019; 30:301-311. [PMID: 31008817 PMCID: PMC6551248 DOI: 10.1097/jnc.0000000000000075] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) is an increasingly important part of the HIV prevention armamentarium. Issues with PrEP, however, include access. We propose that one way to surmount this issue would be to have nurses provide PrEP. Although clinical guidelines exist for PrEP, they are overwhelmingly not targeted to nonprescriber clinicians. In this article, we overview current U.S. and Canadian PrEP guidelines and provide explicit guidance about how nurses can provide PrEP, including the clinical pathways and medical directives we use in our clinic. We call nurse-led provision of PrEP, PrEP-RN (Pre-Exposure Prophylaxis-Registered Nurse) and feel it may be an important step forward in HIV prevention.
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Affiliation(s)
- Patrick O'Byrne
- Patrick O'Byrne, RN-EC, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Paul MacPherson, MD, PhD, is a Staff Physician, Division of Infectious Diseases, The Ottawa Hospital, Ontario, Canada. Lauren Orser, RN, is a Master's Student, School of Nursing, University of Ottawa, Ontario, Canada. Jean Daniel Jacob, RN, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Dave Holmes, RN, PhD, is a Professor of Nursing, University of California, Irvine, California, USA
| | - Paul MacPherson
- Patrick O'Byrne, RN-EC, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Paul MacPherson, MD, PhD, is a Staff Physician, Division of Infectious Diseases, The Ottawa Hospital, Ontario, Canada. Lauren Orser, RN, is a Master's Student, School of Nursing, University of Ottawa, Ontario, Canada. Jean Daniel Jacob, RN, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Dave Holmes, RN, PhD, is a Professor of Nursing, University of California, Irvine, California, USA
| | - Lauren Orser
- Patrick O'Byrne, RN-EC, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Paul MacPherson, MD, PhD, is a Staff Physician, Division of Infectious Diseases, The Ottawa Hospital, Ontario, Canada. Lauren Orser, RN, is a Master's Student, School of Nursing, University of Ottawa, Ontario, Canada. Jean Daniel Jacob, RN, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Dave Holmes, RN, PhD, is a Professor of Nursing, University of California, Irvine, California, USA
| | - Jean Daniel Jacob
- Patrick O'Byrne, RN-EC, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Paul MacPherson, MD, PhD, is a Staff Physician, Division of Infectious Diseases, The Ottawa Hospital, Ontario, Canada. Lauren Orser, RN, is a Master's Student, School of Nursing, University of Ottawa, Ontario, Canada. Jean Daniel Jacob, RN, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Dave Holmes, RN, PhD, is a Professor of Nursing, University of California, Irvine, California, USA
| | - Dave Holmes
- Patrick O'Byrne, RN-EC, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Paul MacPherson, MD, PhD, is a Staff Physician, Division of Infectious Diseases, The Ottawa Hospital, Ontario, Canada. Lauren Orser, RN, is a Master's Student, School of Nursing, University of Ottawa, Ontario, Canada. Jean Daniel Jacob, RN, PhD, is an Associate Professor of Nursing, University of Ottawa, Ontario, Canada. Dave Holmes, RN, PhD, is a Professor of Nursing, University of California, Irvine, California, USA
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Przybyla SM, Parks K, Bleasdale J, Sawyer J, Morse D. Awareness, knowledge, and attitudes towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among pharmacy students. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:352-360. [PMID: 31040011 PMCID: PMC6800069 DOI: 10.1016/j.cptl.2019.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/26/2018] [Accepted: 01/05/2019] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The purpose of this study was to assess pharmacy students' awareness, knowledge, and perceptions towards human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), confidence and intentions to counsel patients on PrEP, and preferred PrEP training. METHODS A web-based cross-sectional survey was conducted with pharmacy students. Descriptive statistics and multivariate logistic regressions were performed. RESULTS Ninety-one percent of participants were aware of PrEP and 61% were familiar with PrEP prescription guidelines. In multivariate analysis, greater PrEP knowledge, attitudes towards PrEP, and familiarity with prescribing guidelines were significantly associated with confidence in PrEP counseling (p < 0.01 for all). Males had significantly higher odds of reporting confidence in PrEP counseling relative to their female counterparts (p < 0.01). Relative to fourth year students, second year students were less likely to report confidence in PrEP counseling (p < 0.01). Participants who were familiar with prescribing guidelines had significantly higher odds of PrEP counseling intentions (p < 0.05). Preferred educational topics regarding PrEP included training on side effects and adherence monitoring (65% and 51%, respectively). The most preferred modalities for receiving PrEP education were online education (47%), educational seminars in required courses (43%), and self-study modules (39%). CONCLUSIONS Given the key role played by pharmacists in patient engagement, they may be presented with opportunities to provide PrEP counseling and education. The development of educational modules for pharmacy students in an effort to increase PrEP uptake should consider addressing gaps in knowledge and preferred training modalities.
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Affiliation(s)
- Sarahmona M Przybyla
- University at Buffalo School of Public Health and Health Professions, 3435 Main Street, 305 Kimball Tower, Buffalo, NY 14214, United States.
| | - Kathleen Parks
- University at Buffalo Clinical and Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States.
| | - Jacob Bleasdale
- University at Buffalo School of Public Health and Health Professions, 3435 Main Street, 320 Kimball Tower, Buffalo, NY 14214, United States.
| | - Joshua Sawyer
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 701 Ellicott Street, Room B2-139, Buffalo, NY 14203, United States.
| | - Diane Morse
- University of Rochester School of Medicine and Dentistry, 2613 West Henrietta Road, Rochester, NY 14623, United States.
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Connect the Dots—January 2019. Obstet Gynecol 2019; 133:183-184. [DOI: 10.1097/aog.0000000000003036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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