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.
Similar content being viewed by others
References
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
IQVIA. IQVIA: Research and Development. 2018. https://www.iqvia.com/solutions/research-and-development.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
Corresponding author
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.
Rights and permissions
About this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-019-02545-1