Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system

Identifying candidates for HIV pre-exposure prophylaxis (PrEP) is a barrier to improving PrEP uptake in priority populations. Syphilis infection is an indication for PrEP in all individuals and can be easily assessed by primary care providers (PCP) and health systems. This retrospective study evaluated the impact of a multidisciplinary provider outreach intervention on PrEP uptake in patients with a positive syphilis test result in a safety-net hospital-based primary care practice. The PCPs of PrEP-eligible patients with a positive syphilis result were notified via the electronic medical record (EMR) about potential PrEP eligibility and institutional HIV PrEP resources. Rates of PrEP offers and prescriptions were compared in the pre (8/1/2018-12/31/2018, n = 60) and post (1/1/2019-5/31/2019, n = 86) intervention periods. Secondary analyzes evaluated receipt of appropriate syphilis treatment and contemporaneous screening for HIV, gonorrhea, and chlamydia. No significant differences in the overall proportion of patients offered (15% vs 19%) and prescribed (7% vs 5%) PrEP were observed between the pre- and post-periods. Overall, 7% of positive tests represented infectious syphilis. The rate of appropriate syphilis treatment was equivalent (57% vs 56%) and contemporaneous screening for other sexually transmitted infections was suboptimal across the entire study period. Although any positive syphilis test may be an easily abstracted metric from the EMR, this approach was inclusive of many patients without current HIV risk and did not increase PrEP uptake significantly. Future research into population health approaches to increase HIV prevention should focus on patients with infectious syphilis and other current risk factors for incident HIV infection.

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The Experience of Primary Care Providers With an Integrated Mental Health Care Program in Safety-Net Clinics

Family & Community Health ◽

10.1097/fch.0000000000000067 ◽

2015 ◽

Vol 38 (2) ◽

pp. 158-168 ◽

Cited By ~ 6

Author(s):

Wayne D. Bentham ◽

Anna Ratzliff ◽

David Harrison ◽

Ya-Fen Chan ◽

Steven Vannoy ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Care Program ◽

Primary Care Providers ◽

Safety Net ◽

Care Providers ◽

Health Care Program ◽

Safety Net Clinics ◽

Integrated Mental Health

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Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers

International Journal of Mental Health Systems ◽

10.1186/s13033-019-0272-0 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 4

Author(s):

Edith K. Wakida ◽

Elialilia S. Okello ◽

Godfrey Z. Rukundo ◽

Dickens Akena ◽

Paul E. Alele ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Health System ◽

Primary Healthcare ◽

Primary Care Providers ◽

Care Providers

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864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1059 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S523-S524

Author(s):

Genevieve Allen ◽

Jamie Riddell

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Family Medicine ◽

Hiv Testing ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Providers ◽

Care Providers ◽

Academic Medical ◽

Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

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Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.4.325 ◽

2021 ◽

Vol 33 (4) ◽

pp. 325-344

Author(s):

Erik D. Storholm ◽

Allison J. Ober ◽

Matthew L. Mizel ◽

Luke Matthews ◽

Matthew Sargent ◽

...

Keyword(s):

Primary Care ◽

Claims Data ◽

Primary Care Providers ◽

Attitudes And Beliefs ◽

Care Providers ◽

Provider Education ◽

Prescribing Practices ◽

Sexually Transmitted ◽

Primary Care Settings ◽

Exposure Prophylaxis

Increasing access to pre-exposure prophylaxis (PrEP) in primary care settings for patients who may be at risk for HIV could help to increase PrEP uptake, which has remained low among certain key risk populations. The current study conducted interviews with primary care providers identified from national claims data as having either high or low likelihood of serving PrEP-eligible patients based on their prescribing practices for other sexually transmitted infections. The study yielded important information about primary care providers’ knowledge, attitudes, and beliefs about PrEP, as well as the barriers and facilitators to prescribing PrEP. Key recommendations for a provider-focused intervention to increase PrEP prescribing among primary care providers, including increasing patient education to increase demand from providers, enhancing provider education, leveraging technology, and instituting standardized sexual health checks, are provided with the goal of informing network-based interventions.

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Knowledge and self-efficacy for caring for breast and colon cancer survivors among safety net primary care providers

Supportive Care in Cancer ◽

10.1007/s00520-019-05277-z ◽

2020 ◽

Vol 28 (10) ◽

pp. 4923-4931

Author(s):

Niharika Dixit ◽

Nancy Burke ◽

Gladys Rodriguez ◽

Urmimala Sarkar ◽

Barbara Cicerelli ◽

...

Keyword(s):

Primary Care ◽

Colon Cancer ◽

Cancer Survivors ◽

Self Efficacy ◽

Primary Care Providers ◽

Safety Net ◽

Care Providers

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Primary care providers’ beliefs and practices on colorectal cancer screening in Kuwait

European Journal of Public Health ◽

10.1093/eurpub/ckz186.095 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

E L Tolma ◽

S M Aljunid ◽

M N Amrizal ◽

J Longenecker ◽

A Al-Basmy ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Cancer Screening ◽

Health System ◽

Screening Test ◽

Primary Care Providers ◽

Screening Tests ◽

Care Providers ◽

Beliefs And Practices ◽

Crc Screening

Abstract Background Colorectal cancer (CRC) is a major public health issue in the Arab region. In Kuwait, CRC is the second most frequent cancer, with an age-standardized (world) incidence rate of 13.2 cases/100,000 in 2018. Despite the national efforts to promote CRC screening the current participation rate is very low (5 to 17%). Primary Care Providers (PCPs) are considered as the gatekeepers of cancer screening globally. This is one of the first studies in Kuwait that examined the current beliefs/practices of PCPs on CRC screening. Methods This cross-sectional study was conducted at governmental primary care centers in Kuwait from 2015-2017. Of 564 PCPs invited to participate from all centers, 255 completed the self-administered questionnaires. The 14-page survey contained 75 questions on PCPs’ beliefs and practices of CRC screening. Data were analyzed by using descriptive statistics. Results The study sample consisted primarily of females (52.0%) and non-Kuwaiti (79%) physicians, with mean age =43.3 (SD: 11.2) years. Most respondents (92%) believed that colonoscopy is the most effective screening tool. The majority (78%) reported that they recommend CRC screening to their patients, with colonoscopy as the most frequent modality (87%) followed by the Faecal Occult Blood Test (FOBT) (52%). Around 40% of the respondents stated that they did not have time to discuss CRC screening with their patients. The majority (72%) believed that their patients did not complete their CRC screening tests. Health system related barriers included difficulties in obtaining test results from the gastroenterologist (61.4%), ordering follow-up test after a positive screening test (50.6%) and shortage of trained staff to conduct the screening test (44.2%). Conclusions A majority of PCPs in Kuwait recommend CRC screening to their patients, but not all patients follow through their recommendation. More research is needed to find out how to further enhance patient uptake of CRC screening. Key messages Colonoscopy is the most frequent screening CRC modality used in Kuwait. Health system related factors can be important future intervention targets to promote CRC screening.

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