Skip to main content

Advertisement

SpringerLink
Log in

HIV-Related Training and Correlates of Knowledge, HIV Screening and Prescribing of nPEP and PrEP Among Primary Care Providers in Southeast United States, 2017

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

The Southeast accounted for most HIV diagnoses (52%) in the United States in 2015. Primary care providers (PCPs) play a vital role in HIV prevention for at-risk persons and treatment of persons living with HIV. We studied HIV-related training, knowledge, and clinical practices among PCPs in the Southeast to address knowledge gaps to inform HIV prevention strategies. Between April and August 2017, we conducted an on-line survey of a representative sample of PCPs in six Southeast jurisdictions with high rates of HIV diagnoses (Atlanta; Baltimore; Baton Rouge; District of Columbia; Miami; New Orleans). We defined HIV-related training as self-reported completion of any certified HIV/STD course or continuing education in past 24 months (prior to survey completion). We assessed associations between training and HIV testing practices, familiarity with nonoccupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP), and ever prescribing nPEP or PrEP. There were 820 participants after fielding 4595 surveys (29.6% adjusted response rate). In weighted analyses, 36.3% reported HIV-related training. Using adjusted prevalence ratio (aPR) and confidence intervals (CI), we found that PCPs with HIV-related training (compared to those with no training) were more likely to be familiar with nPEP (aPR = 1.32, 95% CI 1.05, 1.67) and PrEP (aPR = 1.67, 95% CI 1.19, 2.38); and to have ever prescribed PrEP to patients (aPR = 1.75, 95% CI 1.10, 2.78). Increased HIV-related trainings among PCPs in high HIV prevalence Southeast jurisdictions may be warranted. Strengthening nPEP and PrEP familiarity among PCPs in Southeast may advance national HIV prevention goals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. HIV Surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areas, 2017. 2018. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-vol-29.pdf.

  2. U.S. Department of Commerce: U.S. Census Bureau. Census Regions and Division of the United States. 2018. https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. Accessed 8 May 2018.

  3. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2015. HIV Surv Suppl Rep. 2017;22(2):24.

    Google Scholar 

  4. Arnold T, Brinkley-Rubinstein L, Chan PA, et al. Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi. PLoS ONE. 2017;12(2):e0172354.

    PubMed  PubMed Central  Google Scholar 

  5. Parker CM, Garcia J, Philbin MM, Wilson PA, Parker RG, Hirsch JS. Social risk, stigma and space: key concepts for understanding HIV vulnerability among black men who have sex with men in New York City. Cult Health Sex. 2017;19(3):323–37.

    PubMed  Google Scholar 

  6. Mannheimer S, Wang L, Wilton L, et al. Infrequent HIV testing and late HIV diagnosis are common among a cohort of black men who have sex with men in 6 US cities. J Acquir Immune Defic Syndr. 2014;67(4):438–45.

    PubMed  PubMed Central  Google Scholar 

  7. Kuhns L, Hotton A, Schneider J, Garofalo R, Fujimoto K. Use of pre-exposure prophylaxis (PrEP) in young men who have sex with men is associated with race, sexual risk behavior and peer network size. AIDS Behav. 2017;21(5):1376–82.

    PubMed  PubMed Central  Google Scholar 

  8. Korthuis PT, Berkenblit GV, Sullivan LE, et al. General internists’ beliefs, behaviors, and perceived barriers to routine HIV screening in primary care. AIDS Educ Prev. 2011;23(Suppl 3):70–83.

    PubMed  PubMed Central  Google Scholar 

  9. McNaghten AD, Valverde E, Blair J, Johnson C, Freedman M, Sullivan P. Routine HIV testing among providers of HIV care in the United States, 2009. PLoS ONE. 2013;8(1):e51231.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Dorell C, Sutton M, Oster A, et al. Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic. AIDS Patient Care STDS. 2011;25(11):657–64.

    PubMed  Google Scholar 

  11. Branson B, Handsfield HH, Lampe M, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. 2006;55(RR-14):1–17.

    PubMed  Google Scholar 

  12. Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institutes of Health, et al. Recommendations for HIV prevention with adults and adolescents with HIV in the United States, 2014: Summary for Clinical Providers. 2014. http://stacks.cdc.gov/view/cdc/26063.

  13. Blackstock O, Moore B, Berkenblit G, et al. A cross-sectional online survey of HIV pre-exposure prophylaxis adoption among primary care physicians. J Gen Intern Med. 2017;32(1):62–70.

    PubMed  Google Scholar 

  14. Karris M, Beekmann S, Mehta S, Anderson C, Polgreen P. Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada. Clin Infect Dis. 2014;58(5):704–12.

    CAS  PubMed  Google Scholar 

  15. Tripathi A, Ogbuanu C, Monger M, Gibson J, Duffus W. Preexposure prophylaxis for HIV infection: healthcare providers’ knowledge, perception, and willingness to adopt future implementation in the southern US. South Med J. 2012;105(4):199–206.

    PubMed  Google Scholar 

  16. Blumenthal J, Jain S, Krakower D, et al. Knowledge is Power! Increased provider knowledge scores regarding pre-exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP. AIDS Behav. 2015;19(5):802–10.

    PubMed  PubMed Central  Google Scholar 

  17. Clement ME, Seidelman J, Wu J, et al. An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern US. AIDS Care. 2017;30(5):1–6.

    Google Scholar 

  18. Du Mont J, MacDonald S, Myhr T, Loutfy M. Sustainability of an HIV PEP program for sexual assault survivors: “lessons learned” from health care providers. Open AIDS J. 2011;5:102–12.

    PubMed  PubMed Central  Google Scholar 

  19. Sutton M, Duke C, Geter A, et al. HIV-related knowledge, beliefs, attitudes and practices of primary care providers in the southeastern United States: Survey-linked education to strengthen the HIV prevention workforce (unpublished) 2018.

  20. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in United States, 2010–2015. HIV AIDS Surveillance Project. 2018. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 21 Sept 2018.

  21. IQVIA. IQVIA: Research and Development. 2018. https://www.iqvia.com/solutions/research-and-development.

  22. The American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys, 9th edition. 2016. https://www.aapor.org/AAPOR_Main/media/publications/Standard-Definitions20169theditionfinal.pdf. Accessed 4 Sept 2018.

  23. Chattopadhyay B, Kelley K. Estimation of the coefficient of variation with minimum risk: a sequential method for minimizing sampling error and study cost. Multivar Behav Res. 2016;51(5):627–48.

    Google Scholar 

  24. Farley J, Stewart J, Kub J, Cumpsty Fowler C, Lowensen K, Becker K. Development of The Johns Hopkins University School of Nursing adult/geriatric primary care nurse practitioner program in HIV prevention, treatment, and care. J Assoc Nurses AIDS Care. 2016;27(3):223–33.

    PubMed  Google Scholar 

  25. Portillo C, Stringari Murray S, Fox C, Monasterio E, Rose C. The HIV Primary Care Workforce of Tomorrow: the UCSF integrated HIV/AIDS primary care capacity nurse practitioner program. J Assoc Nurses AIDS Care. 2016;27(3):214–22.

    PubMed  Google Scholar 

  26. Auerbach J, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS. 2015;29(2):102–10.

    PubMed  PubMed Central  Google Scholar 

  27. Shirreffs A, Lee D, Henry J, Golden M, Stekler J. Understanding barriers to routine HIV screening: knowledge, attitudes, and practices of healthcare providers in King County, Washington. PLoS ONE. 2012;7(9):e44417.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Human Resources and Servicess Administration. The U.S. nursing workforce: Trends in supply and education. 2013. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nursingworkforcetrendsoct2013.pdf. Accessed 4 Sept 2018.

  29. Castel A, Feaster D, Tang W, et al. Understanding HIV care provider attitudes regarding intentions to prescribe PrEP. J Acq Immun Defic Syndr. 2015;70(5):520–8.

    Google Scholar 

  30. Centers for Disease Control and Prevention. CDC Vital Signs: daily pill can prevent HIV. 2015. https://www.cdc.gov/vitalsigns/hivprep/index.html. Accessed 4 Sept 2018.

  31. Cardo D, Culver D, Ciesielski C. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. New Engl J Med. 1997;337(21):1485–90.

    CAS  PubMed  Google Scholar 

  32. Calabrese S, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize “Truvada Whores”. Am J Public Health. 2015;105(10):1960–4.

    PubMed  PubMed Central  Google Scholar 

  33. McDoom MM, Bokhour B, Sullivan M, Drainoni M-L. How older black women perceive the effects of stigma and social support on engagement in HIV care. AIDS Patient Care STDs. 2015;29(2):95–101.

    PubMed  Google Scholar 

  34. Saha S, Korthuis PT, Cohn J, Sharp V, Moore R, Beach M. Primary care provider cultural competence and racial disparities in HIV care and outcomes. J Gen Intern Med. 2013;28(5):622–9.

    PubMed  PubMed Central  Google Scholar 

  35. Gaston GB. African-Americans’ perceptions of health care provider cultural competence that promote HIV medical self-care and antiretroviral medication adherence. AIDS Care. 2013;25(9):1159–65.

    PubMed  Google Scholar 

  36. Kuhar D, Henderson D, Struble K, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875–92.

    PubMed  Google Scholar 

  37. Centers for Disease Control and Prevention. Antiretroviral post-exposure prophylaxis after sexual, injection-drug use, or other non-occupational exposure to HIV in the United States. MMWR Recomm Rep. 2005;54:1–2.

    Google Scholar 

  38. Centers for Disease Control and Prevention. Perspectives in disease prevention and health promotion update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health care settings. MMWR. 1988;37(24):377–88.

    Google Scholar 

  39. Centers for Disease Control and Prevention. PEP 101. 2018. https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-pep101.pdf. Accessed 2 Feb 2018.

  40. Rodríguez A, Castel A, Parish C, et al. HIV medical providers’ perceptions of the use of antiretroviral therapy as nonoccupational postexposure prophylaxis in 2 major metropolitan areas. J Acquir Immune Defic Syndr. 2013;64(Suppl 1):S68–79.

    PubMed  Google Scholar 

  41. Minniear T, Gilmore B, Arnold S, Flynn P, Knapp K, Gaur A. Implementation of and barriers to routine HIV screening for adolescents. Pediatrics. 2009;124(4):1076–84.

    PubMed  Google Scholar 

  42. Simmons E, Brown M, Sly K, Ma M, Sutton M, McLellan-Lemal E. Barriers and facilitators to HIV testing in primary care among health care providers. J Natl Med Assoc. 2011;103(5):432–8.

    PubMed  Google Scholar 

  43. Sullivan K, Berger M, Quinlivan E, et al. Perspectives from the field: HIV testing and linkage to care in North Carolina. J Int Assoc Provid AIDS Care. 2016;15(6):477–85.

    PubMed  Google Scholar 

  44. Weis K, Liese A, Hussey J, et al. A routine HIV screening program in a South Carolina community health center in an area of low HIV prevalence. AIDS Patient Care STDs. 2009;23(4):251–8.

    PubMed  Google Scholar 

  45. Davis T, Teaster P, Thornton A, Watkins J, Alexander L, Zanjani F. Primary care providers’ HIV prevention practices among older adults. J Appl Gerontol. 2016;35(12):1325–42.

    PubMed  Google Scholar 

  46. Lanier Y, Castellanos T, Barrow R, Jordan W, Caine V, Sutton M. Brief sexual histories and routine HIV/STD testing by medical providers. AIDS Patient Care STDs. 2014;28(3):113–20.

    PubMed  PubMed Central  Google Scholar 

  47. Beer L, Weiser J, West B, Duke C, Gremel G, Skarbinski J. Delivery of HIV transmission risk-reduction services by HIV care providers in the United States-2013. J Intl Assoc Provid AIDS Care. 2016;15(6):494–504.

    Google Scholar 

  48. Goyal M, Dowshen N, Mehta A, Hayes K, Lee S, Mistry R. Pediatric primary care provider practices, knowledge, and attitudes of human immunodeficiency virus screening among adolescents. J Pediatr. 2013;163(6):1711–5.

    PubMed  PubMed Central  Google Scholar 

  49. O’Leary S, Hurley L, Kennedy E, et al. Provider attitudes regarding vaccine tracking systems in pediatric practices. Acad Pediatr. 2016;16(1):34–41.

    PubMed  Google Scholar 

  50. Jensen J, Weng C, Spraker Perlman H. A provider-based survey to assess bereavement care knowledge, attitudes, and practices in pediatric oncologists. J Palliat Med. 2017;20(3):266–72.

    PubMed  PubMed Central  Google Scholar 

  51. McManus RJ, Wood S, Bray EP, et al. Self-monitoring in hypertension: a web-based survey of primary care physicians. J Hum Hypertens. 2014;28(2):123–7.

    CAS  PubMed  Google Scholar 

  52. Shirts B, Perera S, Hanlon J, et al. Provider management of and satisfaction with laboratory testing in the nursing home setting: results of a national internet-based survey. J Am Med Dir Assoc. 2009;10(3):161–6.

    PubMed  PubMed Central  Google Scholar 

  53. Ward K, Jacobson J, Turok D, Murphy P. A survey of provider experience with misoprostol to facilitate intrauterine device insertion in nulliparous women. Contraception. 2011;84(6):594–9.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the participating K-BAP providers. We also thank the data collection and data security teams at Altarum Institute. The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. No financial disclosures were reported by authors of this paper.

Funding

Centers for Disease Control and Prevention (Contract # 200-2015-F-87651).

Author information

Authors and Affiliations

  1. Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-45, Atlanta, GA, 30329, USA

    Kirk D. Henny, Angelica Geter, Zaneta Gaul, Kate Buchacz & Madeline Y. Sutton

  2. Altarum Institute, Ann Arbor, MI, USA

    Christopher C. Duke, Chantell Frazier & Jennifer Peterson

  3. ICF, Atlanta, GA, USA

    Zaneta Gaul

Authors
  1. Kirk D. Henny
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher C. Duke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelica Geter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zaneta Gaul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chantell Frazier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jennifer Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kate Buchacz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Madeline Y. Sutton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kirk D. Henny.

Ethics declarations

Conflicts of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 39 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Henny, K.D., Duke, C.C., Geter, A. et al. HIV-Related Training and Correlates of Knowledge, HIV Screening and Prescribing of nPEP and PrEP Among Primary Care Providers in Southeast United States, 2017. AIDS Behav 23, 2926–2935 (2019). https://doi.org/10.1007/s10461-019-02545-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-019-02545-1

Keywords

Search

Navigation