Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study

Sexual Health ◽  
2020 ◽  
Vol 17 (6) ◽  
pp. 485
Author(s):  
Mattea Lazarou ◽  
Lisa Fitzgerald ◽  
Melissa Warner ◽  
Sandra Downing ◽  
Owain D. Williams ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Health ◽  
Professional Training ◽  
Healthcare Providers ◽  
Prevention Measures ◽  
Barriers To Access ◽  
Study Results ◽  
Rural Access ◽  
Exposure Prophylaxis ◽  
Interdisciplinary Healthcare

Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers’ (HCP) knowledge and preparedness to prescribe PrEP remains limited. Methods: Semistructured interviews, conducted before PBS listing (October 2016–April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. Results: Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia’s universal healthcare insurance system). Conclusions: Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.

scholarly journals Pre-Exposure Prophylaxis Training among Medical Schools in the United States

2021 ◽  
Vol 12 ◽  
pp. 215013272110287
Author(s):  
Robert L. Cooper ◽  
Mohammad Tabatabai ◽  
Paul D. Juarez ◽  
Aramandla Ramesh ◽  
Matthew C. Morris ◽  
...  
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Injection Drug Users ◽  
Drug Users ◽  
Healthcare Providers ◽  
Medical Schools ◽  
The United States ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Exposure Prophylaxis

Pre-Exposure Prophylaxis (PrEP) has been shown to be an effective method of HIV prevention for men who have sex with-men (MSM) and -transgender women (MSTGWs), serodiscordant couples, and injection drug users; however fewer than 50 000 individuals currently take this regimen. Knowledge of PrEP is low among healthcare providers and much of this lack of knowledge stems from the lack or exposure to PrEP in medical school. We conducted a cross sectional survey of medical schools in the United States to assess the degree to which PrEP for HIV prevention is taught. The survey consisted Likert scale questions assessing how well the students were prepared to perform each skill associated with PrEP delivery, as well as how PrEP education was delivered to students. We contacted 141 medical schools and 71 responded to the survey (50.4%). PrEP education was only reported to be offered at 38% of schools, and only 15.4% reported specific training for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. The most common delivery methods of PrEP content were didactic sessions with 11 schools reporting this method followed by problem-based learning, direct patient contact, workshops, and small group discussions. Students were more prepared to provide PrEP to MSM compared to other high-risk patients. Few medical schools are preparing their students to prescribe PrEP upon graduation. Further, there is a need to increase the number of direct patient contacts or simulations for students to be better prepared.

scholarly journals Lessons Learned from Longer Acting Reversible Contraception Applied to Longer Acting HIV Prevention Technologies

2021 ◽  
Author(s):  
Rachel Logan ◽  
Dominika Seidman
Keyword(s):  
Hiv Prevention ◽  
Reproductive Health ◽  
Sexual Health ◽  
Lessons Learned ◽  
Reproductive Justice ◽  
Holistic View ◽  
Marginalized Communities ◽  
Exposure Prophylaxis

Abstract Purpose of Review This review describes lessons learned from longer acting contraception and employs a reproductive justice lens to inform expansion of emerging HIV prevention technologies. Recent Findings Reproductive justice is a framework that advocates for the promotion of universal sexual and reproductive freedoms, particularly among historically marginalized communities. This framework takes a holistic view of individuals and sees the interconnections between sexual health, reproductive health, and overall health. Employing a sexual and reproductive justice perspective is essential to understanding and helping to mitigate the role intersecting structural, sexual, and reproductive oppressions, including those demonstrated through promotion of longer acting contraception, and can critically inform rollout of future prevention technologies, such as longer acting HIV pre-exposure prophylaxis. Summary This review highlights the need for researchers, clinicians, and policymakers to apply lessons learned from contraception and specifically focuses on principles of reproductive justice to offer expanding HIV prevention options.

scholarly journals 1273. Reasons for Disengagement in Care among Individuals Receiving Pre-Exposure Prophylaxis (PrEP) from a Sexual Health Clinic

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S458-S458
Author(s):  
Jason Zucker ◽  
Deborah Theodore ◽  
Caroline Carnevale ◽  
Elijah LaSota ◽  
Paul Richards ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Health ◽  
Hiv Risk ◽  
Perceived Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Health Clinic ◽  
Receptive Anal Intercourse ◽  
Online Questionnaire ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) effectively reduces HIV acquisition, but its efficacy depends on continued engagement through periods of high and low risk. Persistence in HIV prevention care has been low in real-world settings. In our program, 32% of patients are lost to care after their first visit and only 35% of patients are retained at their planned third visit. Reasons for low persistence in care are poorly described. Methods We identified all MSM who started PrEP between July 2015 and June 2018 at a sexual health clinic in an urban academic medical center in New York and had not had a visit in ≥6 months. We called patients between July 2018 and January 2019; those who were English speaking were given the option to complete an online questionnaire about current PrEP status, reasons for disengagement, and social and behavioral determinants of health (SBDH). Results Up to 710 patients were eligible for the study; over 700 calls were made. 125 participants agreed to participate and 57 (46%) completed the questionnaire. 24 patients (42%) were still actively taking PrEP. The most common reasons for starting PrEP were fear of getting HIV (58%), high self-perceived HIV risk (28%), and recommendations from friends (26%). Among those no longer taking PrEP, the most common reasons for discontinuation were cost/insurance issues (32%), lower perceived HIV risk (18%), concern about long-term side effects (12%), and trouble attending every-3-month appointments (12%). For those stopping due to lower perceived risk, 40% were in a monogamous relationship, 60% were less sexually active, and 20% always used a condom or did not engage in receptive anal intercourse. 56% of patients had at least 1 major life event in the preceding 3 months, including loss of a job (25%), breakup with a partner (12%), illness or death of a family member (11%), or unstable housing (8%). 47% used drugs or alcohol before sex in the past month including 39% not on PrEP. Conclusion Reasons for engagement, disengagement, and re-engagement are highly variable at the individual level. Cost and insurance issues were common in spite if clinic resources available to cover the cost of visits and medications. Life trauma was common. Individualized interventions to address SBDH may be required to engage and retain individuals in HIV prevention care. Disclosures All authors: No reported disclosures.

scholarly journals Comparing HIV Post-Exposure Prophylaxis, Testing, and New Diagnoses in Two Australian Cities with Different Lockdown Measures during the COVID-19 Pandemic

2021 ◽  
Vol 18 (20) ◽  
pp. 10814
Author(s):  
Eric P. F. Chow ◽  
Jason J. Ong ◽  
Basil Donovan ◽  
Rosalind Foster ◽  
Tiffany R. Phillips ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Rate Ratio ◽  
Hiv Transmission ◽  
Incidence Rate Ratio ◽  
Sexual Partners ◽  
Post Exposure Prophylaxis ◽  
Prevention Measures ◽  
Post Exposure ◽  
Number Of Sexual Partners ◽  
Exposure Prophylaxis

Australia introduced a national lockdown on 22 March 2020 in response to the COVID-19 pandemic. Melbourne, but not Sydney, had a second COVID-19 lockdown between July and October 2020. We compared the number of HIV post-exposure prophylaxis (PEP) prescriptions, HIV tests, and new HIV diagnoses during these lockdown periods. The three outcomes in 2020 were compared to 2019 using incidence rate ratio. There was a 37% and 46% reduction in PEP prescriptions in Melbourne and Sydney, respectively, with a larger reduction during lockdown (68% and 57% reductions in Melbourne’s first and second lockdown, 60% reduction in Sydney’s lockdown). There was a 41% and 32% reduction in HIV tests in Melbourne and Sydney, respectively, with a larger reduction during lockdown (57% and 61% reductions in Melbourne’s first and second lockdowns, 58% reduction in Sydney’s lockdown). There was a 44% and 47% reduction in new HIV diagnoses in Melbourne and Sydney, respectively, but no significant reductions during lockdown. The reduction in PEP prescriptions, HIV tests, and new HIV diagnoses during the lockdown periods could be due to the reduction in the number of sexual partners during that period. It could also result in more HIV transmission due to substantial reductions in HIV prevention measures during COVID-19 lockdowns.

scholarly journals Mathematical Modeling of HIV Prevention Measures Including Pre-Exposure Prophylaxis on HIV Incidence in South Korea

PLoS ONE ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. e90080 ◽  
Author(s):  
Sun Bean Kim ◽  
Myoungho Yoon ◽  
Nam Su Ku ◽  
Min Hyung Kim ◽  
Je Eun Song ◽  
...  
Keyword(s):  
Mathematical Modeling ◽  
Hiv Prevention ◽  
South Korea ◽  
Hiv Incidence ◽  
Prevention Measures ◽  
Exposure Prophylaxis

Views of HIV-negative partners in heterosexual serodiscordant relationships regarding HIV pre-exposure prophylaxis: a qualitative study

Sexual Health ◽  
2016 ◽  
Vol 13 (4) ◽  
pp. 345 ◽  
Author(s):  
Joana R. S. P. Falcão ◽  
Catriona C. Bradshaw ◽  
Cameryn C. Garrett ◽  
Jade E. Bilardi ◽  
Marcus Y. Chen ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Social Research ◽  
Sexual Practices ◽  
Heterosexual Relationships ◽  
Structured Interviews ◽  
Serodiscordant Couples ◽  
Study Results ◽  
Effective Option ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Background Pre-exposure prophylaxis (PrEP) may be an effective option for HIV prevention among heterosexual serodiscordant couples. However, there are knowledge gaps in social research about PrEP in heterosexual serodiscordant relationships, including motivations and barriers to its use and possible impacts of PrEP uptake on the sexual practices of these couples. The aim of this study was to explore the views of HIV-negative men and women in stable serodiscordant heterosexual relationships about the possible use of PrEP. Methods: Semi-structured interviews were used to understand participants’ views on the use of PrEP. Interviews were conducted face-to-face or by telephone and transcribed verbatim for thematic analysis. Results: In total, 13 HIV-negative partners were interviewed; six men and seven women. Participants demonstrated a high interest in the use of PrEP for conception. PrEP was also considered an option for general HIV prevention, although men saw more benefits for this use than women. Participants’ main concerns around PrEP usage were about cost, efficacy, daily adherence and side-effects. HIV-positive partner support is likely to play a central role for PrEP uptake and adherence. Conclusions: This study is one of the first studies to explore the views of HIV-negative heterosexual partners in serodiscordant relationships around the use of PrEP while trying to conceive, as well as for general HIV prevention. These study results provide new insights for the further development of guidelines governing the use of PrEP for serodiscordant couples.

scholarly journals Stigma and Confidentiality Indiscretions: Intersecting Obstacles to the Delivery of Pre-Exposure Prophylaxis to Adolescent Girls and Young Women in East Zimbabwe

2021 ◽  
pp. 237-248
Author(s):  
Morten Skovdal ◽  
Phyllis Magoge-Mandizvidza ◽  
Rufurwokuda Maswera ◽  
Melinda Moyo ◽  
Constance Nyamukapa ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Adolescent Girls ◽  
Young Women ◽  
Scale Up ◽  
Healthcare Providers ◽  
Local Health ◽  
Individual Interviews ◽  
Biomedical Hiv Prevention ◽  
Sub Saharan ◽  
Exposure Prophylaxis

AbstractDespite efforts to scale-up biomedical HIV prevention technologies, such as oral pre-exposure prophylaxis (PrEP), many countries and regions of the world are far off–track in reaching global HIV prevention targets. Uptake of, and adherence to PrEP amongst adolescent girls and young women (AGYW) in sub-Saharan Africa has proved particularly challenging. Drawing on qualitative individual interviews and focus group discussions with thirty AGYW in east Zimbabwe, as well as interviews with healthcare providers, we investigate some of the root causes of this challenge, namely the social risks involved with accessing PrEP. We find that stigma and the worry of AGYW that privacy and confidentiality cannot be maintained in local health clinics and by local healthcare providers, presents a major barrier to the uptake of PrEP. We call for interventions that recognise the need to tackle the range of socio-cultural norms and social practices that interact and in synergy make engagement with PrEP an (im)possible and (un)desirable thing to do for AGYW.

scholarly journals Pre-Exposure Prophylaxis (PrEP) Uptake among Black Men Who Have Sex with Men (BMSM) in the Southern U.S.

2021 ◽  
Vol 18 (18) ◽  
pp. 9715
Author(s):  
Oluwafemi Adeagbo ◽  
Sayward Harrison ◽  
Shan Qiao ◽  
Xiaoming Li
Keyword(s):  
Hiv Prevention ◽  
Black Men ◽  
Healthcare Providers ◽  
Rapid Expansion ◽  
Hiv Care ◽  
Hiv Incidence ◽  
Interdisciplinary Approaches ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The U.S

Black men who have sex with men (BMSM) living in the United States (U.S.) South are disproportionately affected by HIV and experience significant disparities in HIV incidence, access to HIV care, and prevention across ages and socio-economic statuses. The aim of this commentary is to critically review current literature on the state of PrEP use among BMSM in the U.S. South, including identifying barriers and facilitators to PrEP use in order to inform intervention development. Extant literature shows that despite the documented benefits of PrEP as an effective HIV-prevention method, its uptake among BMSM is limited across the U.S. South. Common barriers to PrEP uptake included stigma, homophobia, mistrust of healthcare systems, negative attitudes from healthcare providers, access and transportation issues, poverty, and misinformation about PrEP. These barriers are likely to have been further exacerbated by the COVID-19 pandemic. Limited access to PrEP and other HIV-prevention programs, such as HIV testing, post-exposure prophylaxis (PEP), and condoms for BMSM are likely increase HIV incidence in this community. Moreover, the rapid expansion of telehealth services during the COVID-19 period may offer increased opportunity to scale-up PrEP through telehealth interventions, especially if in-person services remain limited due to pandemic precautions. Given the intersectional barriers that limit the access and uptake of PrEP among BMSM, we suggest that tailored programs or interventions that seek to address PrEP disparities among Southern BMSM should adopt intersectional and interdisciplinary approaches to better understand the complex challenges of scaling up PrEP. More studies are needed to investigate the impact of COVID-19 on HIV-prevention services among BMSM and to understand how to co-develop—with the BMSM community and healthcare providers—culturally acceptable interventions to reduce the identified challenges using intersectional and interdisciplinary approaches.

scholarly journals Risk perception, safer sex practices and PrEP enthusiasm: barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK

2020 ◽  
Vol 96 (5) ◽  
pp. 349-354 ◽  
Author(s):  
Sarah E Nakasone ◽  
Ingrid Young ◽  
Claudia S Estcourt ◽  
Josina Calliste ◽  
Paul Flowers ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sexual Health ◽  
Health Knowledge ◽  
Safer Sex ◽  
Black African ◽  
Caribbean Women ◽  
Black Caribbean ◽  
African Black ◽  
Exposure Prophylaxis ◽  
Sexual Health Knowledge

ObjectivesUK Black African/Black Caribbean women remain disproportionately affected by HIV. Although oral pre-exposure prophylaxis (PrEP) could offer them an effective HIV prevention method, uptake remains limited. This study examined barriers and facilitators to PrEP awareness and candidacy perceptions for Black African/Black Caribbean women to help inform PrEP programmes and service development.MethodsUsing purposive sampling through community organisations, 32 in-depth, semi-structured interviews were conducted with Black African/Black Caribbean women living in London and Glasgow between June and August 2018. Participants (aged 19–63) included women of varied HIV statuses to explore perceptions of sexual risk and safer sex, sexual health knowledge and PrEP attitudes. A thematic analysis guided by the Social Ecological Model was used to explore how PrEP perceptions intersected with wider safer sex understandings and practices.ResultsFour key levels of influence shaping safer sex notions and PrEP candidacy perceptions emerged: personal, interpersonal, perceived environment and policy. PrEP-specific knowledge was low and some expressed distrust in PrEP. Many women were enthusiastic about PrEP for others but did not situate PrEP within their own safer sex understandings, sometimes due to difficulty assessing their own HIV risk. Many felt that PrEP could undermine intimacy in their relationships by disrupting the shared responsibility implicit within other HIV prevention methods. Women described extensive interpersonal networks that supported their sexual health knowledge and shaped their interactions with health services, though these networks were influenced by prevailing community stigmas.ConclusionsDifficulty situating PrEP within existing safer sex beliefs contributes to limited perceptions of personal PrEP candidacy. To increase PrEP uptake in UK Black African/Black Caribbean women, interventions will need to enable women to advance their knowledge of PrEP within the broader context of their sexual health and relationships. PrEP service models will need to include trusted ‘non-sexual health-specific’ community services such as general practice.

scholarly journals Facilitators and barriers of 2-1-1 HIV pre-exposure prophylaxis

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251917
Author(s):  
Christina Camp ◽  
Parya Saberi
Keyword(s):  
Hiv Prevention ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Facilitators And Barriers ◽  
Sexual Encounters ◽  
Prevention Method ◽  
Sex With Men ◽  
Dosing Strategy ◽  
Exposure Prophylaxis

An alternative strategy for men who have sex with men (MSM) experiencing challenges with daily HIV pre-exposure prophylaxis (PrEP) includes 2-1-1 dosing. Understanding 2-1-1 PrEP facilitators and barriers, especially during the SARS-CoV-2 pandemic, may guide researchers and healthcare providers in future studies and clinical preparedness. We conducted a national cross-sectional study of MSM in the US who had taken 2-1-1 PrEP to examine facilitators and barriers of this on-demand PrEP dosing option. With the shelter-in-place orders in March 2020, this study was adapted to include questions on how the SARS-CoV-2 pandemic affected participants’ PrEP use. A total of 140 individuals participated in the survey, 106 of which completed questions pertaining to the SARS-CoV-2 pandemic. The most common reasons for switching from once-daily to 2-1-1 PrEP included having sex less frequently (63.6%) and wanting to take fewer pills (46.4%). Participants reported high medication adherence based on each component of 2-1-1 PrEP dosing (>84%). The most common barriers with 2-1-1 PrEP dosing included unplanned sexual encounters resulting in missing the double-dose pre-sex (43.6%) and trouble remembering doses post-sex (29.3%). Facilitators of the 2-1-1 PrEP dosing strategy included reductions in sexual encounters (63.6%), preference to take fewer pills (46.4%), need to reduce cost (22.1%), and desire to reduce side effects (19.3%). Challenges to receiving PrEP services during the pandemic included obtaining laboratory testing (25.5%) and PrEP refills (either receipt of a refill authorization from a healthcare provider or processing of a refill from the pharmacy) (18.9%). 2-1-1 PrEP is an effective HIV prevention method; therefore, understanding facilitators and barriers of this dosing strategy can result in continuous provision of HIV prevention efforts, particularly during a pandemic.

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