Abstract
BackgroundPre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation.ObjectiveThe objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition.MethodsThis intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients’ history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs’ ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention.ResultsThe intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up.ConclusionsGiven the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the PrEP continuum of care is needed.
Highlights
Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in randomized clinical trials [1,2,3,4,5,6] and demonstration projects [7,8,9], but PrEP uptake in the United States has not been concomitant with need [10,11,12]
Despite the Centers for Disease Control and Prevention (CDC)’s definition of HIV prevention as a core family planning service, the authors noted that only 38% correctly defined PrEP, 37% understood the effectiveness of PrEP, and only 36% of respondents consulted PrEP guidelines
A total of 6 health care providers (HCPs) gave us feedback on their experience with PrEP Optimization Intervention (PrEP-OI) after 1 month of use in December 2016
Summary
Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in randomized clinical trials [1,2,3,4,5,6] and demonstration projects [7,8,9], but PrEP uptake in the United States has not been concomitant with need [10,11,12]. Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Conclusions: Given the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the PrEP continuum of care is needed
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