Pre-Exposure Prophylaxis: A Narrative Review of Provider Behavior and Interventions to Increase PrEP Implementation in Primary Care

Abstract Background Pre-exposure prophylaxis (PrEP) in the form of daily tenofovir disoproxil fumarate (TDF/FTC) is a potentially transformative tool to prevent HIV infection. However, PrEP scale-up in the United States has been slow and difficult to evaluate comprehensively. All payer claims databases (APCDs) are large datasets that contain information on medical and pharmaceutical claims from most public and private payers in each state, and provide an unusual opportunity to evaluate statewide PrEP implementation efforts. Methods We used 2012–2017 data from Rhode Island’s APCD and developed an algorithm to identify individuals prescribed TDF/FTC for PrEP. We compared APCD PrEP data to electronic medical record (EMR) data at the largest dedicated PrEP program in the state, and to other comprehensive pharmaceutical claims data (AIDSVu.org). We calculated the PrEP-to-Need ratio (PnR) based on annual HIV incidence, and used multivariable logistic regression to predict ZIP code-level PrEP use, and specialty of prescribing provider (primary care vs. infectious disease). Results The Rhode Island APCD included insurance claims for 917,633 individuals (87% of the Rhode Island population). PrEP use increased substantially in Rhode Island over the 5-year period, from 13 to 331 prescriptions between 2012 and 2017, with 546 total users during this time period. Users were predominantly male (89%) and privately insured (69.1%), and concentrated in Providence County (71.5%). The PnR ratio increased from 0.2 to 4.0 from 2012–2017. Compared with AIDSVu and EMR Data, the APCD underestimated the number of PrEP users in Rhode Island, but improved over time in documenting users. Infectious diseases specialists had 8.4 times the odds (95% CI: 5.4 to 12.9) of being a PrEP prescriber compared with primary care providers. A total of 2.6% of infectious disease specialists were PrEP prescribers compared with 0.33% of PCPs. The proportion of Black or Hispanic individuals in a ZIP-code was not a significant predictor of PrEP use. Conclusion APCDs offer an innovative approach to evaluate statewide PrEP implementation comprehensively. Engaging PCPs in PrEP implementation is critical to improve overall uptake among populations most at-risk. Disclosures All authors: No reported disclosures.

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Faculty Opinions recommendation of Role of the geriatrician, primary care practitioner, nurses, and collaboration with oncologists during cancer treatment delivery for older adults: A narrative review of the literature.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733223947.793547071 ◽

2018 ◽

Author(s):

Maria-José Molina-Garrido

Keyword(s):

Older Adults ◽

Primary Care ◽

Cancer Treatment ◽

Narrative Review ◽

Review Of The Literature ◽

Primary Care Practitioner ◽

Treatment Delivery

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Equity considerations in outcome measures of the HIV pre-exposure prophylaxis care continuum in high-income countries: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-040701 ◽

2021 ◽

Vol 11 (2) ◽

pp. e040701

Author(s):

Melissa Cabecinha ◽

Danielle Solomon ◽

Greta Rait ◽

John Saunders ◽

Hamish Mohammed ◽

...

Keyword(s):

Systematic Review ◽

English Language ◽

Outcome Measure ◽

Assessment Tool ◽

Public Health Practice ◽

Risk Groups ◽

Care Continuum ◽

Quantitative Studies ◽

Prep Implementation ◽

Exposure Prophylaxis

IntroductionHIV pre-exposure prophylaxis (PrEP) is an effective intervention to reduce acquisition of HIV. PrEP provision has increased in recent years, however, it is not known whether PrEP implementation has been equitably implemented across all risk groups, particularly groups experiencing high levels of health inequity. A PrEP care continuum (PCC) has been proposed to evaluate the success of PrEP implementation programmes, but the extent to which health equity characteristics are currently taken into account in the PCC has not been described. The objectives of this proposed systematic review are to (i) identify and collate outcome measure definitions for the main stages of the PCC (awareness, acceptability, uptake, adherence and retention), (ii) describe how equity characteristics are considered in outcome definitions of the PCC and (iii) describe data sources for capturing equity characteristics.Methods and analysisQuantitative studies published between 1 January 2012 and 3 March 2020 will be included. Five databases (MEDLINE, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts) will be searched to identify English language publications that include an outcome measure definition of at least one of the five main stages of the PCC. Risk of bias will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Data on outcome measure definitions and equity characteristics will be extracted. Results will be presented in a narrative synthesis and all findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Ethics and disseminationEthical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete. The review findings will have relevance to healthcare professionals, policymakers and commissioners in informing how to best evaluate PrEP implementation programmes and inform new implementation strategies for vulnerable and less advantaged populations.PROSPERO registration numberCRD42020169779.

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1289. Knowledge, Attitudes and Barriers of Pre-exposure Prophylaxis for HIV Infection Among Resident Physicians in Rural, Eastern North Carolina

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1122 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S394-S394

Author(s):

Arianne Morrison ◽

Ciarra Dortche ◽

Nada Fadul

Keyword(s):

Primary Care ◽

North Carolina ◽

Hiv Infection ◽

Sexual Behaviors ◽

Residency Program ◽

Primary Care Physicians ◽

Online Survey ◽

Risky Sexual Behaviors ◽

Resident Physicians ◽

Exposure Prophylaxis

Abstract Background North Carolina bears a high burden of HIV and was ranked number 8 for the number of new infections in 2015. In 2014, the Centers for Disease Control and Prevention (CDC) published updated practice guidelines recommending the use of pre-exposure prophylaxis (PrEP) with daily oral dosing of tenofovir/emtricitabine to help prevent HIV infection in high-risk individuals. However, the use of PrEP in the primary care setting remains low and 1 in three primary care physicians is not aware of PrEP. The objective of our study was to evaluate PrEP knowledge among primary care resident physicians. Methods 149 resident physicians were surveyed at East Carolina University from the following specialties; Internal Medicine, Medicine-Pediatrics, Obstetrics Gynecology and Family Medicine. We collected participants’ age, biological sex, current residency program, and current year within the residency program. Results Sixty out 149 residents completed the online survey. 20% of residents had never heard of PrEP. 17% of residents did not feel comfortable discussing sexual preferences with their patients. 15% of residents thought prescribing would increase risky sexual behaviors and 12% would not prescribe PrEP to patients with multiple sexual partners. Only 3% of residents identified potential side effects of PrEP (e.g., an increase in creatinine levels or decrease in mineral bone density) as a reason to not prescribe PrEP. One resident had ever prescribed PrEP. 83% of residents wanted more information on PrEP and 95% of residents would be willing to prescribe PrEP if educational workshops were offered. Conclusion PrEP is an underutilized tool among resident physicians in Eastern, NC. We identified lack of knowledge of PrEP and concern for increased risky sexual behaviors as barriers to prescribing. Resident physicians require more education on PrEP in order to prescribe it to their patients. Disclosures All authors: No reported disclosures.

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Estimating the Costs of Implementing Comprehensive Primary Care: A Narrative Review

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392819842484 ◽

2019 ◽

Vol 6 ◽

pp. 233339281984248

Author(s):

Grant R. Martsolf ◽

Ryan Kandrack ◽

Mark W. Friedberg ◽

Brian Briscombe ◽

Peter S. Hussey ◽

...

Keyword(s):

Primary Care ◽

Narrative Review ◽

Fee For Service ◽

Primary Care System ◽

High Functioning ◽

Illness Burden ◽

Care Practices ◽

Primary Care Practices ◽

Limited Generalizability ◽

Care System

The performance of the any health-care system relies on a high-functioning primary care system. Increasing primary care practices’ adoption of “comprehensive primary care” capabilities might yield meaningful improvements in the quality and efficiency of primary care. However, many comprehensive primary care capabilities, such as care management and coordination, are not compensated via traditional fee-for-service payment. To calculate new payments for these capabilities, policymakers would need estimates of the costs that practices incur when adopting, maintaining, and using the capabilities. We performed a narrative review of the existing literature on the costs of adopting and implementing comprehensive primary care capabilities. These studies have found that practices incur significant costs when adopting and implementing comprehensive primary care capabilities. However, the studies had significant limitations that prevent extensive use of their estimates for payment policy. Particularly, the strongest studies focused on a small numbers of practices in specific geographic areas and the concepts and methods used to assess costs varied greatly across the studies. Furthermore, none of the studies in our review attempted to estimate differences in costs across practices with patients at varying levels of complexity and illness burden which is important for risk-adjusting payments to practices. Therefore, due to the heterogeneous designs and limited generalizability of published studies highlight the need for additional research, especially if payers wish to link their financial support for comprehensive primary care capabilities to the costs of these capabilities for primary care practices.

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Provider Adherence to Pre-exposure Prophylaxis Monitoring Guidelines in a Large Primary Care Network

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy099 ◽

2018 ◽

Vol 5 (6) ◽

Cited By ~ 13

Author(s):

Matthew A Spinelli ◽

Hyman M Scott ◽

Eric Vittinghoff ◽

Albert Y Liu ◽

Alicia Morehead-Gee ◽

...

Keyword(s):

Primary Care ◽

Laboratory Monitoring ◽

Care Network ◽

Sexually Transmitted ◽

Hiv Resistance ◽

Panel Management ◽

Provider Adherence ◽

Exposure Prophylaxis ◽

Test Ordering ◽

Large Primary

Abstract Insufficient pre-exposure prophylaxis (PrEP) laboratory monitoring could increase HIV resistance and sexually transmitted infections. We examined test-ordering in a primary care network. Providers did not order HIV testing before almost one-quarter of PrEP initiations; panel management was associated with higher testing. Effective monitoring is needed to maximize PrEP’s preventive impact.

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Pregabalin for the treatment of neuropathic pain: a narrative review for primary care providers

Current Medical Research and Opinion ◽

10.1080/03007995.2017.1322051 ◽

2017 ◽

Vol 33 (8) ◽

pp. 1353-1359 ◽

Cited By ~ 2

Author(s):

Yvonne D’Arcy ◽

Bill McCarberg ◽

Bruce Parsons ◽

Regina Behar ◽

Andrew Thorpe ◽

...

Keyword(s):

Primary Care ◽

Neuropathic Pain ◽

Primary Care Providers ◽

Narrative Review ◽

Care Providers

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Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China

Sexual Health ◽

10.1071/sh17075 ◽

2018 ◽

Vol 15 (1) ◽

pp. 39 ◽

Cited By ~ 11

Author(s):

Chunxing Liu ◽

Yingying Ding ◽

Zhen Ning ◽

Meiyang Gao ◽

Xing Liu ◽

...

Keyword(s):

Hiv Risk ◽

Intervention Study ◽

Implementation Strategies ◽

Self Assessment ◽

Risk Beliefs ◽

Group Data ◽

Prep Implementation ◽

Substantial Risk ◽

Sex With Men ◽

Exposure Prophylaxis

Background: Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. However, its uptake among men who have sex with men (MSM) is low in China. The study aimed to identify factors that might influence MSM’s uptake and use of PrEP. Methods: In-depth interviews were conducted with 32 self-identified MSM from a PrEP intervention study evaluating daily oral tenofovir disoproxil fumarate (TDF) to prevent HIV infection. Of these men, 11 were presently using the ‘TDF’ group; 8 from the ‘change-over’ group (i.e. initially used PrEP but subsequently quitted); and 13 from the non-user group. Data were analysed using thematic approach. Results: Perception of low HIV risk, mistrust of the national PrEP program, and concerns of side effects were the main reasons for not wanting to use PrEP. Also, lack of main sexual partner’s support, difficulties in adhering to the daily TDF regimen, and the inconvenient schedules in securing the medicine were the major reasons for not wanting to use or quitting the use of PrEP. On the other hand, perceived high HIV risk, beliefs in efficacy of PrEP, and worries of transmitting HIV to families were the major motives for PrEP uptake. Conclusions: Findings suggest that PrEP implementation strategies should first address issues including but not limited to accurate self-assessment of HIV risk, mistrust and limited knowledge about medical trials and PrEP, and ease of accessing PrEP.

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