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HIV Providers’ Perceived Barriers and Facilitators to Implementing Pre-exposure Prophylaxis in Care Settings: A Qualitative Study

AIDS and Behavior volume 18, pages 1712–1721 (2014)Cite this article

Abstract

Oral pre-exposure prophylaxis (PrEP) can reduce HIV incidence among at-risk persons. However, for PrEP to have an impact in decreasing HIV incidence, clinicians will need to be willing to prescribe PrEP. HIV specialists are experienced in using antiretroviral medications, and could readily provide PrEP, but may not care for HIV-uninfected patients. Six focus groups with 39 Boston area HIV care providers were conducted (May–June 2012) to assess perceived barriers and facilitators to prescribing PrEP. Participants articulated logistical and theoretical barriers, such as concerns about PrEP effectiveness in real-world settings, potential unintended consequences (e.g., risk disinhibition and medication toxicity), and a belief that PrEP provision would be more feasible in primary care clinics. They identified several facilitators to prescribing PrEP, including patient motivation and normative guidelines. Overall, participants reported limited prescribing intentions. Without interventions to address HIV providers’ concerns, implementation of PrEP in HIV clinics may be limited.

Resumen

La profilaxis pre-exposición via oral (PrEP) puede reducir la incidencia del VIH entre las personas en situación de riesgo. Sin embargo, para que PrEP tenga un impacto en la disminución de la incidencia del VIH, los médicos tienen que estar dispuestos a prescribir PrEP. Los especialistas en VIH tienen experiencia en el uso de medicamentos antirretrovirales, y podría proporcionar PrEP fácilmente, pero puede que no atiendan a pacientes no infectados por VIH. Se realizaron seis grupos focales con 39 proveedores de atención del VIH en el área de Boston (mayo-junio de 2012) para evaluar la percepción de barreras y facilitadores para la prescripción de PrEP. Los participantes articularon barreras logísticas y teóricas, como las preocupaciones sobre la eficacia de PrEP en el mundo real, las posibles consecuencias no deseadas (por ejemplo, riesgo de desinhibición y toxicidad de medicamentos), y la creencia de que la administración de PrEP sería más factible en las clínicas de atención primaria. Varios facilitadores para la prescripcion de PrEP fueron identificados, incluyendo la motivación del paciente y directrices normativas. En general, los participantes reportaron intenciones de prescripción limitadas. Sin intervenciones que hagan frente a las preocupaciones de los proveedores de atencion del VIH, la implementación de PrEP en las clínicas de VIH puede ser limitada.

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Acknowledgments

This research was supported by grants to Dr. Krakower from the National Institute of Mental Health (NIMH K23MH098795) and the AMA Foundation. The authors would like to thank the study participants and would like to acknowledge the help of Jon Trinidad for his role as a research assistant on this project.

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Affiliations

  1. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St., WLMOB, Suite GB, Boston, MA, 02215, USA

    Douglas Krakower, Jennifer A. Mitty, Kevin Maloney & Kenneth H. Mayer

  2. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Norma Ware

  3. The Fenway Institute, Boston, MA, USA

    Kenneth H. Mayer

  4. Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA

    Kenneth H. Mayer

Authors
  1. Douglas Krakower
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  2. Norma Ware
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  3. Jennifer A. Mitty
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  4. Kevin Maloney
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  5. Kenneth H. Mayer
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Correspondence to Douglas Krakower.

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Krakower, D., Ware, N., Mitty, J.A. et al. HIV Providers’ Perceived Barriers and Facilitators to Implementing Pre-exposure Prophylaxis in Care Settings: A Qualitative Study. AIDS Behav 18, 1712–1721 (2014). https://doi.org/10.1007/s10461-014-0839-3

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  • DOI: https://doi.org/10.1007/s10461-014-0839-3

Keywords

  • HIV prevention
  • Pre-exposure prophylaxis
  • Healthcare provider
  • Implementation

Palabras clave

  • Prevención del VIH
  • Profilaxis pre-exposición
  • Proveedor de atención médica
  • Implementación