Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review. AIDS Patient Care STDS 2020 Mar;34(3):111-123
Date
02/29/2020Pubmed ID
32109141Pubmed Central ID
PMC7087402DOI
10.1089/apc.2019.0189Scopus ID
2-s2.0-85082342702 (requires institutional sign-in at Scopus site) 119 CitationsAbstract
Increasing prescription of pre-exposure prophylaxis (PrEP) is imperative to ending the HIV epidemic in the United States. The objective of this review was to identify health care provider barriers to PrEP implementation. A systematic review was conducted in February 2019 using PubMed to identify barriers to PrEP prescribing practices in the United States. Targeted search terms surrounding PrEP and providers resulted in 222 original studies, 28 of which were ultimately included in our review, with data collected between 2011 and 2018. Six themes were identified across reviewed studies: (i) a lack of PrEP knowledge, (ii) the presence of the Purview Paradox, which refers to discordance in beliefs between HIV specialists and primary care providers on who should prescribe PrEP, (iii) concerns about PrEP costs, (iv) concerns about behavioral and health consequences, (v) interpersonal stigma, and (vi) concerns about patient adherence. A majority of providers were lacking knowledge regarding PrEP, resulting in discomfort in prescribing PrEP, or limited awareness and understanding of PrEP clinical guidelines. Discrepant opinions were identified regarding whether PrEP was best managed within primary care or specialty clinics. Other barriers included concerns about cost, patient adherence, and follow-up maintenance care. Finally, concerns about risk compensation and discomfort discussing sexual activities with patients who would benefit most from PrEP were apparent. Additional work is needed to prepare providers to prescribe and manage patients on PrEP, optimize PrEP delivery, and reduce provider bias. Future research is needed to identify providers' attitudes and beliefs regarding innovations in PrEP dosing, task shifting, and novel strategies for PrEP care.
Author List
Pleuhs B, Quinn KG, Walsh JL, Petroll AE, John SAAuthors
Steven A. John PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of WisconsinAndrew Petroll MD Professor in the Medicine department at Medical College of Wisconsin
Katherine Quinn PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Jennifer L. Walsh PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAnti-HIV Agents
Attitude of Health Personnel
Female
HIV Infections
Health Knowledge, Attitudes, Practice
Health Personnel
Humans
Male
Motivation
Patient Acceptance of Health Care
Patient Compliance
Practice Patterns, Physicians'
Pre-Exposure Prophylaxis
Primary Health Care
Social Stigma
Surveys and Questionnaires
United States
