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

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 P...

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Bibliographic Details
Published in:AIDS and behavior 2014-09, Vol.18 (9), p.1712-1721
Main Authors: Krakower, Douglas, Ware, Norma, Mitty, Jennifer A., Maloney, Kevin, Mayer, Kenneth H.
Format: Article
Language:English
Subjects:
Acquired Immune Deficiency Syndrome
Adult
Aged
Anti-HIV Agents - therapeutic use
Antiretroviral agents
Attitude of Health Personnel
Boston
Boston, Massachusetts
Clinics
Constraints
Female
Focus Groups
Health Knowledge, Attitudes, Practice
Health Personnel - psychology
Health Psychology
Health Services Needs and Demand
HIV
HIV Infections - prevention & control
Human immunodeficiency virus
Humans
Infectious Diseases
Intention
Intervention
Male
Medications
Medicine
Medicine & Public Health
Middle Aged
Motivation
Original Paper
Patients
Perception
Physicians
Pre-Exposure Prophylaxis - methods
Preventive medicine
Primary Health Care
Prophylaxis
Public Health
Qualitative Research
Risk
Surveys and Questionnaires
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Summary: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.
ISSN:1090-7165
1573-3254
DOI:10.1007/s10461-014-0839-3