Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Krakower D, Ware N, Mitty JA, Maloney K, Mayer KH. HIV providers' perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study. AIDS Behav 2014;18:1712-21. [PMID: 24965676 DOI: 10.1007/s10461-014-0839-3] [Citation(s) in RCA: 255] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]

For:	Krakower D, Ware N, Mitty JA, Maloney K, Mayer KH. HIV providers' perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study. AIDS Behav 2014;18:1712-21. [PMID: 24965676 DOI: 10.1007/s10461-014-0839-3] [Citation(s) in RCA: 255] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]

Number

Cited by Other Article(s)

Walker C, Armstrong D, Pitt J, Summers NA, Spears L, Han S, Scruggs S, Anderson JN, Kiles TM, Williams LA, Cernasev A. Implementation and Overall Impressions of a PrEP Bootcamp for Health Care Professional Learners in the Southern United States Designed to Highlight Active Learning, Interdisciplinary Collaboration, and Simulation: A Qualitative Study. J Assoc Nurses AIDS Care 2025;36:237-246. [PMID: 40138464 DOI: 10.1097/jnc.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2025]

Affiliation(s)

Crystal Walker Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Drew Armstrong Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Jamie Pitt Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Nathan A Summers Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
London Spears Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Shannon Han Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Samuel Scruggs Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Janeane N Anderson Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Tyler M Kiles Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
L Alexia Williams Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA
Alina Cernasev Crystal Walker, PhD, DNP, FNP-C, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA, and is an Associate Director of Sexual Health, Community Care, Austin, Texas, USA Drew Armstrong, PharmD, BCACP, BC-ADM, AAHIVP, is an Assistant Professor, The University of Tennessee Health Science Center College of Pharmacy, Memphis, Tennessee, USA, and is a PGY2 Ambulatory Care Residency Director, Regional One Health, Memphis, Tennessee, USA Jamie Pitt, MMHPE, CHSE, is the Director of Education, The University of Tennessee Health Science Center for Healthcare Improvement and Patient Simulation, Memphis, Tennessee, USA Nathan A. Summers, MD, MSc, is a Medical Director, Adult Special Care Clinic at Regional One Hospital, Memphis, Tennessee, USA, and is an Assistant Professor, Division of Infectious Diseases, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA London Spears, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Shannon Han, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Samuel Scruggs, MD, is a Medical Resident, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA Janeane N. Anderson, PhD, MPH, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Tyler M. Kiles, PharmD, BC-ADM, is a Clinical Assistant Professor, Pharmacy Practice Division, The University of Texas at Austin, College of Pharmacy, Austin, Texas, USA L. Alexia Williams, PhD, RN, is an Assistant Professor, The University of Tennessee Health Science Center College of Nursing, Memphis, Tennessee, USA Alina Cernasev, PhD, PharmD, MSc, is an Assistant Professor, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center College of Pharmacy, Nashville, Tennessee, USA

Collapse

Perkins R, Beima-Sofie K, Christopoulos K, Cohen SE, Dright A, Dombrowski JC, Gougougui A, Kohler P, Luetkemeyer AF, Pintye J, Celum C. Another Tool for the Sexual Health Toolkit: US Health Care Provider Knowledge and Attitudes About Doxycycline Postexposure Prophylaxis to Prevent Bacterial Sexually Transmitted Infections Among Men Who Have Sex With Men. Sex Transm Dis 2025;52:129-134. [PMID: 39481014 DOI: 10.1097/olq.0000000000002095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2024]

Orser L, MacPherson P, O'Byrne P, Saeed M. Use of HIV pre-exposure prophylaxis among men who have sex with men: low uptake and retention despite high-risk indications. AIDS Care 2025;37:141-150. [PMID: 39644220 DOI: 10.1080/09540121.2024.2437564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 11/25/2024] [Indexed: 12/09/2024]

Pratt MC, Goymer H, Burgan K, Matthews LT, Johnson B, Phillips D, Kempf MC, Mugavero MJ, Williams A, Elopre LE. Qualitative analysis of patient and key informant interviews to inform integration of HIV pre-exposure prophylaxis services into gynecology care in Alabama. WOMEN'S HEALTH (LONDON, ENGLAND) 2025;21:17455057251331714. [PMID: 40339168 PMCID: PMC12062644 DOI: 10.1177/17455057251331714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 02/24/2025] [Accepted: 03/11/2025] [Indexed: 05/10/2025]

Abstract

BACKGROUND

HIV pre-exposure prophylaxis (PrEP) use is low among Southern, Black cis-gender women (CGW). Gynecology clinics are well-positioned to integrate PrEP services as a component of sexual and reproductive healthcare for CGW.

OBJECTIVES

Identify key determinants to PrEP implementation into routine gynecologic care.

DESIGN

Qualitative, in-depth interviews (IDIs).

METHODS

We conducted IDIs with key informants (i.e., physicians, nurses, medical assistants) and focus group discussions (FGDs) with patients accessing care in a gynecology clinic serving under- and uninsured women in Alabama. IDIs explored individual-, setting-, and process-level factors that may impact PrEP care implementation in a clinic serving approximately 3000 women yearly, 64% of whom are Black women.

RESULTS

Ten key informants participated in individual IDIs (median age 33.5, range 24-58 years, 80% female); 20 women participated in either 1 of 4 FGDs (n = 8) or an individual IDI (n = 12); median age 32, range 19-44. The following themes emerged: (1) patient- and provider-level stigmas related to sexuality, sexually transmitted infections (STIs), and HIV limit discussions about sexual health and HIV prevention. (2) Providers report limited knowledge about prescribing and monitoring PrEP, which is reflected in patient's observations that providers do not routinely initiate discussions about HIV prevention or PrEP. (3) Providers utilize a more risk-based approach to PrEP counseling; patients expect non-targeted, comprehensive sexual health information. (4) Structural and social barriers will be challenges to implementing PrEP in routine gynecological care. (5) Patients and providers support a clinic-wide approach to integration of PrEP into gynecology clinics.

CONCLUSION

Discussions around sexual health and STIs are limited in routine gynecologic care, but patients expect comprehensive counseling from knowledgeable providers. Additional provider training may increase comfort discussing and providing PrEP. These findings will inform development of implementation strategies to integrate PrEP care into gynecologic services.

Collapse

Okafor CN, Yoon J, Heads A, Schmitz J. Understanding Intentions to Discuss Long-Acting Injectable Pre-Exposure Prophylaxis with Healthcare Providers Among Black and Hispanic Gay and Bisexual Men in Texas. J Int Assoc Provid AIDS Care 2025;24:23259582251336662. [PMID: 40304620 PMCID: PMC12046173 DOI: 10.1177/23259582251336662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 03/05/2025] [Accepted: 04/04/2025] [Indexed: 05/02/2025] Open

Lee J, Higashi RT, Hogan TP, Marcus JL, Repasky EC, Torres MB, Krakower D, Nijhawan AE. Linking Criminal Justice-Involved Individuals to HIV Preexposure Prophylaxis: A Qualitative Analysis of Multiple Stakeholder Perspectives. J Int Assoc Provid AIDS Care 2025;24:23259582251341940. [PMID: 40350581 PMCID: PMC12066857 DOI: 10.1177/23259582251341940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 04/09/2025] [Accepted: 04/27/2025] [Indexed: 05/14/2025] Open

Tiruneh YM, Rachmale R, Elerian N, Lakey DL. Assessing Knowledge, Practices, and Barriers to PrEP and nPEP Prescription Among Texas Healthcare Providers. Healthcare (Basel) 2024;12:2315. [PMID: 39595512 PMCID: PMC11593935 DOI: 10.3390/healthcare12222315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 11/12/2024] [Accepted: 11/15/2024] [Indexed: 11/28/2024] Open

Nacht CL, Reynolds HE, Jessup O, Amato M, Storholm ED. The Association between Social Support and Pre-Exposure Prophylaxis use among Sexual Minority Men in the United States: A Scoping Literature Review. AIDS Behav 2024;28:3559-3573. [PMID: 39039399 PMCID: PMC11471694 DOI: 10.1007/s10461-024-04446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/24/2024]

Abstract

Sexual minority men (SMM) are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is an effective way of reducing HIV incidence, PrEP use has remained relatively low. Social support may be one effective factor in increasing PrEP use among SMM, but the association between social support and PrEP use/adherence is not well understood. The objective of this paper was to summarize the current literature on the association of social support and PrEP use among SMM in the United States. A systematic search was conducted using six different databases MEDLINE / PubMed, PsycINFO, Cochrane CENTRAL, Google Scholar, Embase, and Web of Science using terms established from keywords and medical subject headings (MeSH) terms before being adapted to each database. Data were extracted for key study factors (e.g., study population, geographic location, study design) and main findings. This search produced eleven articles: ten manuscripts and one conference abstract. Of these, two were randomized control trials, two were interventions, three were qualitative, and four were cross-sectional. The studies were widespread across the country, but most were in major metropolitan areas. From the articles included in this review, findings were inconsistent in the association between social support; some studies showed null findings, others that only certain sources of social support were significant, and others that there was a significant association between social support and PrEP use. This review highlights the complexity of the relationship between social support and PrEP use among SMM, indicating the need for further research to identify specific types and sources of support that effectively enhance PrEP uptake and adherence. Targeted interventions based on these insights could significantly reduce HIV incidence in the population.

Collapse

Keddem S, Broderick K, Van Epps P, Roberts CB, Chhatre S, Beste LA. Brief communication: The cohort of women prescribed HIV PrEP at the Veterans Health Administration. AIDS Res Ther 2024;21:78. [PMID: 39487544 PMCID: PMC11529397 DOI: 10.1186/s12981-024-00670-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 10/23/2024] [Indexed: 11/04/2024] Open

Urbano AZR, Ferraz D, Raymundo YDL, Zucchi EM. Perceptions and practices of healthcare providers in providing HIV pre-exposure prophylaxis to trans adolescents and young adults and men who have sex with men. Rev Saude Publica 2024;58:10s. [PMID: 39417506 PMCID: PMC11573365 DOI: 10.11606/s1518-8787.2020054005589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2024] Open

Abstract

OBJECTIVE

This study aims to understand the perceptions and practices of healthcare providers regarding the offer of HIV pre-exposure prophylaxis (PrEP) to gay and trans adolescents and young adults.

METHODS

This qualitative research was developed as part of the PrEP1519 study, which was conducted from 2018 to 2021 to analyze the effectiveness of PrEP in adolescents and young adults. Data were collected from July 2020 to February 2021 at the municipality of São Paulo by combining participant observations and semi-structured interviews. The analytical process involved immersion in the empirical material and coding and categorizing it with the support of NVivo®. Interpretation followed the hermeneutic-dialectical principle and had the concept of Care in health practices as its horizon.

RESULTS

The construction of trust-based relationships followed practices that acknowledge the uniqueness of youth and their demands and sought to strengthen their autonomy. Sensitive and supportive listening was pointed out as a welcoming practice that propelled care actions. Welcoming attitudes and support in facing stigma and violence (related or not to the use of PrEP) acknowledged the need to support adolescents and young adults to develop autonomy for prevention. The use of language close to young people's everyday life favored the construction of relationships of trust and positively influenced the development of autonomy and adherence to PrEP. The tension between technical and practical success occurred in the idealized search for adult-centric normativity as opposed to intersubjectivity.

CONCLUSION

The perceptions and practices of healthcare providers are aligned with the concept of Care as they include actions beyond technical knowledge and recognize the contexts that increase the vulnerability of adolescents and young adults to HIV.

Collapse

Duarte FM, Brasil SA, Lima M, Vidal JDS, Magno L, Dourado I, da Silva LAV. Risk and pleasure in the era of pharmacologically safe sex. Rev Saude Publica 2024;58:7s. [PMID: 39417517 PMCID: PMC11573377 DOI: 10.11606/s1518-8787.2024058005962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/28/2024] [Indexed: 10/19/2024] Open

Abstract

OBJECTIVE

This article discusses how Pre-Exposure Prophylaxis (PrEP) and the undetectable viral load=untransmissible (UVL=U) have produced reconfigurations in the contexts of affective-sexual encounters of young gay men/men who have sex with men (MSM) living with HIV (YLHIV).

METHODS

In-depth interviews were conducted with nine YLHIV, aged 18 to 29, from two studies conducted in Salvador, Bahia, in 2019 and 2021. The narratives focused on unprecedented events in the prevention and treatment of HIV/AIDS, which have allowed experiences of greater intimacy and safety but also challenges and tensions in affective-sexual relationships.

RESULTS

Different moments in the experience of living with HIV reveal different narratives of YLHIV concerning the new PrEP and UVL biotechnologies. Concerns surrounding possible HIV transmission or the obligation to reveal serology are more prominent among young people with the most recent diagnosis. In contrast, those with more extended serology experience are more comfortable and confident in the face of new technologies and their significant effects on sexual encounters. However, controversies remain regarding the moral and behavioral consequences of their use. Some YLHIV re-update concerns and bring reports about the continuity of stigma toward people living with HIV. Others emphasize the benefits of biomedical advances, opening up new interactive possibilities, including without the use of condoms, highlighting the existence of other practices, knowledge, dynamics, and ways of negotiating risk/care, with tensions in the field of sexuality itself.

CONCLUSIONS

We reiterate the need to resume public policies in the field of HIV/AIDS beyond biomedical strategies, highlighting vulnerabilities, the dissemination of information about new HIV prevention and treatment technologies, respect for people's autonomy in their preventive choices, and the development of strategies to combat the stigma associated with HIV/AIDS.

Collapse

Price DM, Garretson M, Cai X, Miah F, Scanlin K, Blackstock O, Edelstein Z. Knowledge and Attitudes About HIV Pre-Exposure Prophylaxis Among Sexually Active Black and Latina Cisgender Women: Findings from the 2017 and 2018 New York City Sexual Health Survey. AIDS Patient Care STDS 2024;38:428-437. [PMID: 39229686 DOI: 10.1089/apc.2024.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open

Arnold T, Whiteley L, Giorlando KK, Barnett AP, Albanese AM, Leigland A, Sims-Gomillia C, Elwy AR, Edet PP, Lewis DM, Brock JB, Brown LK. A qualitative study identifying implementation strategies using the i-PARIHS framework to increase access to pre-exposure prophylaxis at federally qualified health centers in Mississippi. Implement Sci Commun 2024;5:92. [PMID: 39198914 PMCID: PMC11350989 DOI: 10.1186/s43058-024-00632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open

Abstract

BACKGROUND

Mississippi (MS) experiences disproportionally high rates of new HIV infections and limited availability of pre-exposure prophylaxis (PrEP). Federally Qualified Health Centers (FQHCs) are poised to increase access to PrEP. However, little is known about the implementation strategies needed to successfully integrate PrEP services into FQHCs in MS.

PURPOSE

The study had two objectives: identify barriers and facilitators to PrEP use and to develop tailored implementation strategies for FQHCs.

METHODS

Semi-structured interviews were conducted with 19 staff and 17 PrEP-eligible patients in MS FQHCs between April 2021 and March 2022. The interview was guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework which covered PrEP facilitators and barriers. Interviews were coded according to the i-PARIHS domains of context, innovation, and recipients, followed by thematic analysis of these codes. Identified implementation strategies were presented to 9 FQHC staff for feedback.

RESULTS

Data suggested that PrEP use at FQHCs is influenced by patient and clinic staff knowledge with higher levels of knowledge reflecting more PrEP use. Perceived side effects are the most significant barrier to PrEP use for patients, but participants also identified several other barriers including low HIV risk perception and untrained providers. Despite these barriers, patients also expressed a strong motivation to protect themselves, their partners, and their communities from HIV. Implementation strategies included education and provider training which were perceived as acceptable and appropriate.

CONCLUSIONS

Though patients are motivated to increase protection against HIV, multiple barriers threaten uptake of PrEP within FQHCs in MS. Educating patients and providers, as well as training providers, are promising implementation strategies to overcome these barriers.

Collapse

Affiliation(s)

Trisha Arnold Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Laura Whiteley Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
Kayla K Giorlando Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA
Andrew P Barnett Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
Ariana M Albanese Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
Avery Leigland Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA
Courtney Sims-Gomillia Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
A Rani Elwy Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
Precious Patrick Edet Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
Demetra M Lewis Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
James B Brock Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
Larry K Brown Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

Collapse

Vanhamel J, Reyniers T, Vuylsteke B, Callens S, Nöstlinger C, Huis in ’t Veld D, Kenyon C, Van Praet J, Libois A, Vincent A, Demeester R, Henrard S, Messiaen P, Allard SD, Rotsaert A, Kielmann K. Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an implementation science framework. J Int AIDS Soc 2024;27 Suppl 1:e26260. [PMID: 38965986 PMCID: PMC11224588 DOI: 10.1002/jia2.26260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/19/2024] [Indexed: 07/06/2024] Open

Abstract

INTRODUCTION

In Belgium, oral HIV pre-exposure prophylaxis (PrEP) is primarily provided in specialized clinical settings. Optimal implementation of PrEP services can help to substantially reduce HIV transmission. However, insights into implementation processes, and their complex interactions with local context, are limited. This study examined factors that influence providers' adaptive responses in the implementation of PrEP services in Belgian HIV clinics.

METHODS

We conducted a qualitative multiple case study on PrEP care implementation in eight HIV clinics. Thirty-six semi-structured interviews were conducted between January 2021 and May 2022 with a purposive sample of PrEP care providers (e.g. physicians, nurses, psychologists), supplemented by 50 hours of observations of healthcare settings and clinical interactions. Field notes from observations and verbatim interview transcripts were thematically analysed guided by a refined iteration of extended Normalisation Process Theory.

RESULTS

Implementing PrEP care in a centralized service delivery system required considerable adaptive capacity of providers to balance the increasing workload with an adequate response to PrEP users' individual care needs. As a result, clinic structures were re-organized to allow for more efficient PrEP care processes, compatible with other clinic-level priorities. Providers adapted clinical and policy norms on PrEP care (e.g. related to PrEP prescribing practices and which providers can deliver PrEP services), to flexibly tailor care to individual clients' situations. Interprofessional relationships were reconfigured in line with organizational and clinical adaptations; these included task-shifting from physicians to nurses, leading them to become increasingly trained and specialized in PrEP care. As nurse involvement grew, they adopted a crucial role in responding to PrEP users' non-medical needs (e.g. providing psychosocial support). Moreover, clinicians' growing collaboration with sexologists and psychologists, and interactions with PrEP users' family physician, became crucial in addressing complex psychosocial needs of PrEP clients, while also alleviating the burden of care on busy HIV clinics.

CONCLUSIONS

Our study in Belgian HIV clinics reveals that the implementation of PrEP care presents a complex-multifaceted-undertaking that requires substantial adaptive work to ensure seamless integration within existing health services. To optimize integration in different settings, policies and guidelines governing PrEP care implementation should allow for sufficient flexibility and tailoring according to respective local health systems.

Collapse

Jackson KJ, McCoy SI, White DAE. A Decade of HIV Preexposure Prophylaxis (PrEP): Overcoming Access Barriers in the United States Through Expanded Delivery. Public Health Rep 2024;139:405-411. [PMID: 38032345 DOI: 10.1177/00333549231208487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open

Miller L, Otieno B, Amboka S, Kadede K, Odeny D, Odhiambo H, Agot I, Zamudio-Haas S, Auerswald C, Bukusi EA, Cohen CR, Truong HHM. "Something Like That": Awareness and Acceptability of HIV PrEP and PEP Among Kenyan Adolescents. Int J Behav Med 2024:10.1007/s12529-024-10290-6. [PMID: 38942977 DOI: 10.1007/s12529-024-10290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 06/30/2024]

Sensalire S, Nkolo A, Ssali JN, Muhire M, Muhwezi A, Kadama H. Applying a Three-Tier Approach to Address Gaps in Oral Pre-Exposure Prophylaxis Uptake and Continuity in Uganda: A Mixed Methods Approach. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024;12:e2300229. [PMID: 38467398 PMCID: PMC11057795 DOI: 10.9745/ghsp-d-23-00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024]

Abstract

BACKGROUND

We describe a 3-tier approach involving a gap analysis, root cause analysis, and pre-exposure prophylaxis (PrEP) collaborative to understand the gap and identify and address the main barriers to oral PrEP uptake and continuity in Uganda.

METHODS

We used a mixed methods design with retrospective, cross-sectional, and prospective components. The gap analysis involved descriptive analysis of PrEP uptake and continuity. The RCA identified the main barriers to initiation and continuity on PrEP among 1,334 clients who declined to start PrEP and 1,266 who missed their appointment but were at risk. The PrEP collaborative tested changes mapped onto specific barriers to optimize the PrEP clinical service delivery. A trend analysis of routinely collected data of the PrEP cascade determined significant shifts and trends in PrEP uptake and continuity.

RESULTS

Only 60% of the high-risk population eligible for PrEP were enrolled, while fewer than 30% of the cumulative number of PrEP users were refilled each quarter. Uncertainty and fear of side effects, perceptions about the harmfulness of the medication, perceived inability to adhere to PrEP, and stigma were the main reasons why clients rejected PrEP. Lack of access to the facility, side effects, pill burden, stigma, perceived low-risk exposure to HIV, and preference of staying at work as opposed to picking up refills affected continuity on PrEP. The collaborative registered statistically significant shifts in PrEP enrollment from 64% to 89% and continuity from 51% to 78% between July 21 and November 22 following the collaborative intervention.

CONCLUSIONS

We recommend using a 3-tier approach for other similar implementation contexts to strengthen PrEP programming, given the marked statistical shift in PrEP uptake and continuity. This begins with understanding the gap and barriers to use among clients, followed by mapping interventions to specific barriers through a quality improvement collaborative.

Collapse

Keddem S, Thatipelli S, Caceres O, Roder N, Momplaisir F, Cronholm P. Barriers and Facilitators to Long-Acting Injectable HIV Pre-Exposure Prophylaxis Implementation in Primary Care Since Its Approval in the United States. J Acquir Immune Defic Syndr 2024;95:370-376. [PMID: 38133586 PMCID: PMC10932839 DOI: 10.1097/qai.0000000000003370] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]

Kamitani E, Mizuno Y, Koenig LJ. Strategies to Eliminate Inequity in PrEP Services in the US South and Rural Communities. J Assoc Nurses AIDS Care 2024;35:153-160. [PMID: 37963267 PMCID: PMC11090982 DOI: 10.1097/jnc.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]

May SB, Giordano TP, Gottlieb A. Generalizable pipeline for constructing HIV risk prediction models across electronic health record systems. J Am Med Inform Assoc 2024;31:666-673. [PMID: 37990631 PMCID: PMC10873846 DOI: 10.1093/jamia/ocad217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/25/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open

Warzywoda S, Fowler JA, Debattista J, Mills DJ, Furuya-Kanamori L, Durham J, Lau CL, Mullens AB, Istiko SN, Santaolaya C, Malhotra J, Dean JA. The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians. Sex Health 2024;21:SH23098. [PMID: 38219736 DOI: 10.1071/sh23098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]

Allan-Blitz LT, Chan K, Adamson P, Klausner JD, Hsu K. The Role of Emergency and Primary Care in Combating the Rise of Gonorrhea: Another Purview Paradox? J Prim Care Community Health 2024;15:21501319241303609. [PMID: 39660675 PMCID: PMC11632869 DOI: 10.1177/21501319241303609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 11/08/2024] [Accepted: 11/13/2024] [Indexed: 12/12/2024] Open

Devlin SA, Ridgway JP, Dawdani A, Enaholo OE, Liegeon G, Kasal N, Pyra M, Hirschhorn LR, Simon J, Haider S, Ducheny K, Johnson AK. Adapting Provider Training and Pre-Exposure Prophylaxis Advertising to Increase Pre-Exposure Prophylaxis Awareness and Uptake Among Black Cisgender Women. AIDS Patient Care STDS 2023;37:574-582. [PMID: 38011350 PMCID: PMC10732154 DOI: 10.1089/apc.2023.0188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open

Abstract

Black cisgender women (hereafter referred to as "women") have disproportionately high rates of HIV infection yet low rates of pre-exposure prophylaxis (PrEP) utilization. Barriers to PrEP uptake exist at the system, provider, and individual/client level. To learn how existing training and advertising can be adapted to address race- and sex-based gaps within PrEP service delivery, we conducted focus groups with providers and Black women. Participants were recruited at three health care organizations in the Midwest and South, screened for eligibility, and consented verbally. Focus groups occurred from August 2022 to February 2023. Women were asked about their knowledge and thoughts on PrEP. Providers were asked about factors influencing their decision-making about PrEP. A codebook was developed based on the Consolidated Framework for Implementation Research. Transcripts were coded using the Stanford Lightning Report Method. We completed four focus groups with 10 providers and 9 focus groups with 25 women. Three major themes emerged: (1) low comfort level and limited cultural sensitivity/competency among providers discussing HIV risk and PrEP with Black women, (2) women's concerns about PrEP's side effects and safety during pregnancy, and (3) lack of Black women representation in PrEP advertisement/educational materials. In addition, women in the South reported general medical mistrust and specific misconceptions about PrEP. PrEP trainings for providers need detailed information about the safety of PrEP for women and should include role-playing to enhance cultural competency. Likewise, PrEP advertisements/materials should incorporate information regarding side effects and images/experiences of Black women to increase PrEP awareness and uptake among this population. Clinical Trial Registration Number: NCT05626452.

Collapse

Lade C, MacPhail C, Rutherford A. Provider views of pre-exposure prophylaxis (PrEP) for cisgender women - where do women fit in HIV elimination in Australia? Sex Health 2023;20:558-565. [PMID: 37903431 DOI: 10.1071/sh23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]

Boedeker D, Zerpa E, Drayer SM. Improving Pre-exposure Prophylaxis Counseling at a Military Women's Health Care Clinic to Champion CDC and Defense Health Agency Recommendations. Mil Med 2023;188:134-140. [PMID: 37948228 DOI: 10.1093/milmed/usad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/14/2023] [Accepted: 03/01/2023] [Indexed: 11/12/2023] Open

Abstract

INTRODUCTION

The CDC updated their guidelines in 2021 to recommend all doctors speak about pre-exposure prophylaxis (PrEP) against human immunodeficiency virus infection with all sexually active patients. In addition, there is a demonstrated need for physicians to counsel patients on PrEP to achieve military readiness. Results from the 2018 Health Related Behaviors Survey indicate 21.8% of U.S. service members were at high risk for human immunodeficiency virus. This improvement project aimed to assess deficiencies in providers' knowledge before and after an educational intervention and describe policies clinics can adopt to adhere to CDC recommendations.

MATERIALS AND METHODS

A pre-intervention survey was distributed to providers at the Walter Reed National Military Medical Center Gynecologic Surgery and Obstetrics clinic. Based on results, an educational lecture and standardized intake form were developed. Following the intervention, a post-survey was distributed to providers. A chart review was performed to determine whether PrEP counseling increased following the intervention.

RESULTS

Forty-seven gynecologic providers were sent a pre- and post-intervention survey. Thirty-seven individuals completed the pre-intervention survey (response rate 78.72%), whereas 18 people completed the post-intervention survey (response rate 38.30%). Descriptive analysis suggested comfort counseling on PrEP, comfort with Defense Health Agency guidance on PrEP, and knowledge of PrEP all increased. In terms of the chart review, 81 charts were reviewed pre- and post-intervention. Although we failed to meet our target counseling rate of 70%, the number of patients who were counseled on or prescribed PrEP following our intervention was statistically significant (P = .013).

CONCLUSIONS

This improvement project increased provider knowledge and comfort with PrEP, but only marginally affected behavior changes among providers. This failure may be related to the specific clinic in which the study was implemented. Further research is needed to facilitate routine counseling of PrEP among military women's health care providers.

Collapse

Bailey VC, Kleinhans AV, Mokgatle MM. Knowledge and attitudes of HIV pre-exposure prophylaxis among nurses in South Africa. Afr J Prim Health Care Fam Med 2023;15:e1-e6. [PMID: 37916728 DOI: 10.4102/phcfm.v15i1.4086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 11/03/2023] Open

Mendonça Gil PK, Conrado DDS, do Nascimento AI, de Azevedo MV, da Cunha JCP, Koch GSR, Maciel CG, Ribeiro AA, Paranhos Filho AC, de Medeiros MJ, Santos-Pinto CDB, Falcão de Oliveira E. HIV pre-exposure prophylaxis and incidence of sexually transmitted infections in Brazil, 2018 to 2022: An ecological study of PrEP administration, syphilis, and socioeconomic indicators. PLoS Negl Trop Dis 2023;17:e0011548. [PMID: 37566639 PMCID: PMC10446216 DOI: 10.1371/journal.pntd.0011548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open

Abstract

BACKGROUND

Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is one of the pillars of a combination prevention strategy for reducing the risk of new infections caused by HIV. The daily use of antiretroviral drugs by individuals who are not infected with HIV is required to prevent infection. Although its efficacy has been well established in the literature, in recent years, the decreased supply of antiretroviral drugs has been associated with an increase in the incidence of sexually transmitted infections (STI) and changes in the social determinants of health. An ecological study was conducted covering a five-year period (2018-2022), starting from the year of initiation of PrEP administration in Brazilian state capitals.

PRINCIPAL FINDINGS

Descriptive analysis was performed, and the spatial distribution of study data was taken into account. Correlation analysis was used to assess the association between PrEP administration, the incidence and detection rate of STI, and socioeconomic data. The southern region showed the highest incidence rates of STI, but the northern and northeastern regions demonstrated the worst socioeconomic indicators, especially those related to illiteracy and basic sanitation. PrEP administration was significantly correlated with illiteracy (ρ = -0.658), per capita income (ρ = 0.622), public garbage collection (ρ = 0.612), syphilis (ρ = 0.628) and viral hepatitis (ρ = 0.419) incidences. Further, all STI were significantly associated with illiteracy and per capita income.

SIGNIFICANCE

Our findings highlight the need to continue exploring PrEP use and rising syphilis rates. In terms of policy, PrEP administration appears to be inversely associated with regions of greater social vulnerability. Further efforts should focus on the social determinants and health needs of this population to improve access to PrEP and reduce social disparities.

Collapse

Affiliation(s)

Paula Knoch Mendonça Gil Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Danilo dos Santos Conrado Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Ana Isabel do Nascimento Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Micael Viana de Azevedo Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
João Cesar Pereira da Cunha Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Gabriel Serrano Ramires Koch Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Camila Guadeluppe Maciel Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Alisson André Ribeiro Faculdade de Engenharias, Arquitetura e Urbanismo e Geografia, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Antonio Conceição Paranhos Filho Faculdade de Engenharias, Arquitetura e Urbanismo e Geografia, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Márcio José de Medeiros Instituto Politécnico, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janerio, Brasil
Cláudia Du Bocage Santos-Pinto Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil
Everton Falcão de Oliveira Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brasil

Collapse

Sheth AN, Enders KP, McCumber M, Psioda MA, Ramakrishnan A, Sales JM. State-level clustering in PrEP implementation factors among family planning clinics in the Southern United States. Front Public Health 2023;11:1214411. [PMID: 37559738 PMCID: PMC10407092 DOI: 10.3389/fpubh.2023.1214411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open

Abstract

Background

Availability of PrEP-providing clinics is low in the Southern U.S., a region at the center of the U.S. HIV epidemic with significant HIV disparities among minoritized populations, but little is known about state-level differences in PrEP implementation in the region. We explored state-level clustering of organizational constructs relevant to PrEP implementation in family planning (FP) clinics in the Southern U.S.

Methods

We surveyed providers and administrators of FP clinics not providing PrEP in 18 Southern states (Feb-Jun 2018, N = 414 respondents from 224 clinics) on these constructs: readiness to implement PrEP, PrEP knowledge/attitudes, implementation climate, leadership engagement, and available resources. We analyzed each construct using linear mixed models. A principal component analysis identified six principal components, which were inputted into a K-means clustering analysis to examine state-level clustering.

Results

Three clusters (C1-3) were identified with five, three, and four states, respectively. Canonical variable 1 separated C1 and C2 from C3 and was primarily driven by PrEP readiness, HIV-specific implementation climate, PrEP-specific leadership engagement, PrEP attitudes, PrEP knowledge, and general resource availability. Canonical variable 2 distinguished C2 from C1 and was primarily driven by PrEP-specific resource availability, PrEP attitudes, and general implementation climate. All C3 states had expanded Medicaid, compared to 1 C1 state (none in C2).

Conclusion

Constructs relevant for PrEP implementation exhibited state-level clustering, suggesting that tailored strategies could be used by clustered states to improve PrEP provision in FP clinics. Medicaid expansion was a common feature of states within C3, which could explain the similarity of their implementation constructs. The role of Medicaid expansion and state-level policies on PrEP implementation warrants further exploration.

Collapse

Casey E, Kaplan-Lewis E, Gala K, Lakew R. Successful Integration of HIV PrEP in Primary Care and Women's Health Clinical Practice: A Model for Implementation. Viruses 2023;15:1365. [PMID: 37376664 DOI: 10.3390/v15061365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open

Skinner A, Stein MD, Dean LT, Oldenburg CE, Mimiaga MJ, Chan PA, Mayer KH, Raifman J. Same-Sex Marriage Laws, Provider-Patient Communication, and PrEP Awareness and Use Among Gay, Bisexual, and Other Men Who have Sex with Men in the United States. AIDS Behav 2023;27:1897-1905. [PMID: 36357809 PMCID: PMC10149581 DOI: 10.1007/s10461-022-03923-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/12/2022]

Valente PK, Rusley JC, Operario D, Biello KB. Readiness to Provide Oral and Injectable PrEP for Sexual and Gender Minority Youth Among Healthcare Providers and Clinics in the U.S. Northeast. J Adolesc Health 2023;72:722-729. [PMID: 36604205 PMCID: PMC10121770 DOI: 10.1016/j.jadohealth.2022.11.246] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/19/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023]

Abstract

PURPOSE

To examine readiness to provide oral and injectable pre-exposure prophylaxis (PrEP) for sexual and gender minority youth (SGMY) and to explore decision-making for HIV prevention strategies (e.g., condom use, daily and event-driven oral PrEP, and injectable PrEP) among healthcare providers.

METHODS

Between February and April 2022, we recruited 31 prescribing providers (M.Ds, D.Os, P.As, and N.Ps) practicing in primary care and specialized clinics in the U.S. Northeast for focus groups or individual interviews. Focus groups and interview transcripts were analyzed using thematic analysis.

RESULTS

Most providers specialized in Pediatrics (42%) or Adolescent Medicine (23%) and 58% had previously prescribed PrEP. Main barriers to PrEP readiness were low PrEP knowledge, limited time for visits, and competing clinical priorities. Organizational factors such as routine HIV/STI testing, PrEP-specific electronic health records templates, and specialized staff (e.g., PrEP navigators) promoted PrEP readiness. Providers held positive attitudes toward injectable PrEP to promote adherence among SGMY, yet barriers to implementation of this modality were identified (e.g., patient anxiety about needles, additional staffing needs). Providers described event-driven oral PrEP as an option for SGMY with episodic HIV risk. Assurances of conditional confidentiality, including preventing disclosure of sensitive information through insurance forms, and shared decision-making facilitated conversations about HIV prevention with SGMY.

DISCUSSION

Future PrEP implementation efforts for SGMY should consider combined efforts targeting provider knowledge about PrEP modalities (e.g., decision aids) and clinic organizational factors (e.g., routine HIV/STI testing, resources to assist providers and patients in navigating the multiple steps between prescription and adherence to PrEP).

Collapse

Saberi P, Mehtani NJ, Sayegh A, Camp CE, Chu C. Understanding HIV Pre-Exposure Prophylaxis Questions of U.S. Health Care Providers: Unique Perspectives from the PrEPline Clinical Teleconsultation Service. Telemed J E Health 2023;29:376-383. [PMID: 35802493 PMCID: PMC10024264 DOI: 10.1089/tmj.2022.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open

Abstract

Introduction: Fewer than a quarter of people considered to have factors associated with HIV acquisition are prescribed pre-exposure prophylaxis (PrEP) in the United States. Prior studies demonstrate disparities in provider comfort and knowledge regarding PrEP, suggesting a need for provider capacity building to support widespread PrEP availability. This study examined real-world PrEP clinical questions/cases from providers to a teleconsultation service to identify knowledge gaps and improve PrEP-related training materials and clinical guidelines. Methods: The National Clinician Consultation Center (NCCC) PrEPline provides educational teleconsultation services on clinical decision-making related to PrEP for U.S. health care providers. The NCCC PrEP consultation data collected between 2017 and 2020 were reviewed and systematically categorized by clinical topics, subtopics, and complexity levels (low, moderate, and high). Results: Within the study period, the PrEPline provided 1,754 teleconsultations. More than three quarters came from advanced practice nurses and physicians. The topics of questions commonly focused on medication-based HIV prevention strategies (22.7%), PrEP laboratory ordering/monitoring (17.4%), and side effects and contraindications (14.6%). The majority of teleconsultations (57.9%) involved sharing information that was directly available/addressed in the Centers for Disease Control and Prevention (CDC) 2017 PrEP Guidelines (i.e., low complexity). Discussion: The low frequency of consultations from nonphysician and non-nurse practitioner providers may suggest a need for increased training and collaborative opportunities for other types of providers. The high percentage of low-complexity inquiries may reveal a desire for capacity-building materials specifically designed for practicing providers (e.g., abridged versions of guidelines). This study may inform future research, best clinical practices, and aid in the development of training materials to increase providers' HIV prevention comfort and knowledge.

Collapse

Empowering Tennessee Pharmacists to Initiate PrEP Using Collaborative Pharmacy Practice Agreements. Clin Pract 2023;13:280-287. [PMID: 36826167 PMCID: PMC9954885 DOI: 10.3390/clinpract13010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open

Babiarz J, Nix CD, Bowden S, Roberts R. Insufficient PrEParation: an assessment of primary care prescribing habits and use of pre-exposure prophylaxis in patients at risk of HIV acquisition at a single medical centre. Sex Transm Infect 2023;99:276-278. [PMID: 36759178 DOI: 10.1136/sextrans-2022-055551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/16/2022] [Indexed: 02/11/2023] Open

Abstract

OBJECTIVES

To assess HIV pre-exposure prophylaxis (PrEP) prescribing habits by primary care providers and the number of patients at risk of HIV acquisition at a single medical centre in the Northwestern USA from 1 July 2018 to 31 June 2020.

METHODS

An electronic cross-sectional survey was administered in April and May 2021 to providers in family medicine, internal medicine, adolescent and young adult health, student health and women's health clinics affiliated with the medical centre with questions pertaining to PrEP prescribing practices. Electronic medical record abstraction was used to quantify the number of eligible patients who sought care in primary care departments and the adherence to PrEP initiation guidelines from 1 July 2018 to 31 June 2020.

RESULTS

74% (61/82) of providers reported familiarity with national clinical practice guidelines for the prevention of HIV infection. 50% (41/82) of respondents were located in family medicine clinics. 57% (47/82) of providers counseled less than one-quarter of those who they identified as at risk of HIV infection. The major barriers to prescribing PrEP were insufficient time and lack of familiarity with guidelines. Of the 4330 eligible patients for PrEP, 8% (337/4330) received at least one PrEP prescription during the study period. For patients newly prescribed PrEP, only 23% (39/170) had appropriate counseling and labs at initiation. The top three qualifying indications for PrEP were identifying as transgender (36%, n=1562), high-risk sexual behaviour (32%, n=1405) and injection drug use (30%, n=1289).

CONCLUSIONS

This study highlights intervention points in the HIV prevention cascade warranting attention in order to achieve the 2025 Ending the HIV Epidemic in the U.S. target for PrEP coverage. These include increasing provider adherence to prescribing guidelines and reducing the logistical barriers to prescribing.

Collapse

Miller AS, Krakower DS, Mayer KH. The Potential of Long-Acting, Injectable PrEP, and Impediments to its Uptake. J Urban Health 2023;100:212-214. [PMID: 36630070 PMCID: PMC9918617 DOI: 10.1007/s11524-022-00711-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/12/2023]

Grant W, Adan MA, Samurkas CA, Quigee D, Benitez J, Gray B, Carnevale C, Gordon RJ, Castor D, Zucker J, Sobieszczyk ME. Effect of Participative Web-Based Educational Modules on HIV and Sexually Transmitted Infection Prevention Competency Among Medical Students: Single-Arm Interventional Study. JMIR MEDICAL EDUCATION 2023;9:e42197. [PMID: 36692921 PMCID: PMC9906317 DOI: 10.2196/42197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]

Abstract

BACKGROUND

The number of new HIV diagnoses in the United States continues to slowly decline; yet, transgender women and men who have sex with men remain disproportionately affected. Key to improving the quality of prevention services are providers who are comfortable broaching the subjects of sexual health and HIV prevention with people across the spectrum of gender identities and sexual orientations. Preservice training is a critical point to establish HIV prevention and sexual health education practices before providers' practice habits are established.

OBJECTIVE

The study aimed to develop participative web-based educational modules and test their impact on HIV prevention knowledge and awareness in future providers.

METHODS

Sexual health providers at an academic hospital, research clinicians, community engagement professionals, and New York City community members were consulted to develop 7 web-based educational modules, which were then piloted among medical students. We assessed knowledge of HIV and sexually transmitted infection prevention and comfort assessing the prevention needs of various patients via web-based questionnaires administered before and after our educational intervention. We conducted exploratory factor analysis of the items in the questionnaire.

RESULTS

Pre- and postmodule surveys were completed by 125 students and 89 students, respectively, from all 4 years of training. Before the intervention, the majority of students had heard of HIV pre-exposure prophylaxis (122/123, 99.2%) and postexposure prophylaxis (114/123, 92.7%). Before the training, 30.9% (38/123) of the students agreed that they could confidently identify a patient who is a candidate for pre-exposure prophylaxis or postexposure prophylaxis; this increased to 91% (81/89) after the intervention.

CONCLUSIONS

Our findings highlight a need for increased HIV and sexually transmitted infection prevention training in medical school curricula to enable future providers to identify and care for diverse at-risk populations. Participative web-based modules offer an effective way to teach these concepts.

Collapse

Magnus M, Yellin H, Langlands K, Balachandran M, Turner M, Jordan J, Ramin D, Kuo I, Siegel M. Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis. THE JOURNAL OF MEDICINE ACCESS 2023;7:27550834231214958. [PMID: 38075520 PMCID: PMC10702399 DOI: 10.1177/27550834231214958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/02/2023] [Indexed: 09/17/2024]

Nacht CL, Felner JK, Muthuramalingam S, Towner W, Ling Grant D, Martos A, Chang JM, Hechter R, Storholm ED. Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care. JOURNAL OF CLINICAL RESEARCH IN HIV AIDS AND PREVENTION 2022;4:15-31. [PMID: 37841674 PMCID: PMC10572105 DOI: 10.14302/issn.2324-7339.jcrhap-22-4371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]

Saberi P, Stoner MCD, Ming K, Lisha NE, Hojilla JC, Scott HM, Liu AY, Steward WT, Johnson MO, Neilands TB. The effect of an HIV preexposure prophylaxis panel management strategy to increase preexposure prophylaxis prescriptions. AIDS 2022;36:1783-1789. [PMID: 35730363 PMCID: PMC9529898 DOI: 10.1097/qad.0000000000003283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Abstract

OBJECTIVE

The HIV preexposure prophylaxis optimization intervention (PrEP-OI) study evaluated the efficacy of a panel management intervention using PrEP coordinators and a web-based panel management tool to support healthcare providers in optimizing PrEP prescription and ongoing PrEP care.

DESIGN

The PrEP-OI study was a stepped-wedge randomized clinical trial conducted across 10 San Francisco Department of Public Health primary care sites between November 2018 and September 2019. Each month, clinics one-by-one initiated PrEP-OI in random order until all sites received the intervention by the study team.

METHODS

The primary outcome was the number of PrEP prescriptions per month. Secondary outcomes compared pre- and postintervention periods on whether PrEP was discussed and whether PrEP-related counseling (e.g., HIV risk assessment, risk reduction counseling, PrEP initiation/continuation assessment) was conducted. Prescription and clinical data were abstracted from the electronic health records. We calculated incidence rate ratios (IRR) and risk ratios (RR) to estimate the intervention effect on primary and secondary outcomes.

RESULTS

The number of PrEP prescriptions across clinics increased from 1.85/month (standard deviation [SD] = 2.55) preintervention to 2.44/month (SD = 3.44) postintervention (IRR = 1.34; 95% confidence interval [CI] = 1.05-1.73; P = 0.021). PrEP-related discussions during clinic visits (RR = 1.13; 95% CI = 1.04-1.22; P = 0.004), HIV risk assessment (RR = 1.40; 95% CI = 1.14-1.72; P = 0.001), and risk reduction counseling (RR = 1.16; 95% CI = 1.03-1.30; P = 0.011) increased from the pre- to the postintervention period. Assessment of PrEP initiation/continuation increased over time during the postintervention period (RR = 1.05; 95% CI = 0.99-1.11; P = 0.100).

CONCLUSIONS

A panel management intervention using PrEP coordinators and a web-based panel management tool increased PrEP prescribing and improved PrEP-related counseling in safety-net primary care clinics.

Collapse

Ramakrishnan A, Sales JM, McCumber M, Powell L, Sheth AN. Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training. Open Forum Infect Dis 2022;9:ofac536. [PMID: 36349276 PMCID: PMC9636854 DOI: 10.1093/ofid/ofac536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open

Martínez-Cajas J, Alvarado-Llano B, Martínez-Buitrago E, Torres-Isasiga J, Arrivillaga M, Camargo P, Galindo-Orrego X, Mueses-Marín H. AC-2020-12-1420.R1 - HIV care providers' familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study. AIDS Care 2022;34:1428-1434. [PMID: 35067114 DOI: 10.1080/09540121.2022.2029813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]

Mizuno Y, Gelaude DJ, Crepaz N, Kamitani E, DeLuca JB, Leighton CA, Wichser ME, Smith DK. Health Care Providers' Views on Clinic Infrastructure and Practice Models That May Facilitate HIV Preexposure Prophylaxis (PrEP) Prescribing: A Qualitative Meta-Synthesis. Health Promot Pract 2022;23:999-1014. [PMID: 34549652 PMCID: PMC8938291 DOI: 10.1177/15248399211038364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

Hill SV, Pratt MC, Elopre L, Smith TV, Simpson T, Lanzi R, Matthews LT. "Let's take that [stop sign] down." Provider perspectives on barriers to and opportunities for PrEP prescription to African American girls and young women in Alabama. AIDS Care 2022;34:1473-1480. [PMID: 35914114 PMCID: PMC9889573 DOI: 10.1080/09540121.2022.2105799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/20/2022] [Indexed: 02/03/2023]

Ramchandani MS, Berzkalns A, Cannon CA, Dombrowski JC, Ocbamichael N, Khosropour CM, Barbee LA, Golden MR. A Demedicalized Model to Provide PrEP in a Sexual Health Clinic. J Acquir Immune Defic Syndr 2022;90:530-537. [PMID: 35499503 PMCID: PMC9283215 DOI: 10.1097/qai.0000000000003005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]

Zapata JP, de St Aubin E, Rodriguez-Diaz CE, Malave-Rivera S. Using a Structural-Ecological Model to Facilitate Adoption of Preexposure Prophylaxis Among Latinx Sexual Minority Men: A Systematic Literature Review. JOURNAL OF LATINX PSYCHOLOGY 2022;10:169-190. [PMID: 37456610 PMCID: PMC10348365 DOI: 10.1037/lat0000204] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]

Abstract

Research has consistently shown that individual, interpersonal, community and structural factors influence the degree to which individuals' access and utilize health care services, and these factors may play a role in explaining racial and ethnic differences in health care outcomes. Differences in HIV prevalence and treatment between Latinx adults and white adults in the U.S. must be considered in the context of these factors. However, much of the existing research connecting these factors and HIV/AIDS outcomes in Latinxs remains disparate, limited in scope, and has yet not been applied to the use of biomedical HIV preventions. The following systematic literature review examined research related to PrEP in Latinx sexual minority men (SMM) to build a structural-ecological framework of the existing research, while identifying gaps in the literature and areas for future research. We searched two electronic databases using a systematic review protocol, screened 71 unique records, and identified 23 articles analyzing data from Latinx SMM and intended and/or actual PrEP-use in the United States. Based on the present review, disparities in PrEP uptake by Latinx SMM could be explained, in part, by examining how all levels of the structural-ecological framework uniquely contributes to how Latinx SMM engage with HIV prevention measures and come to understand PrEP. It is clear from the existing literature base that some of the most prominent barriers deterring Latinx SMM from seeking PrEP services are the lack of information surrounding PrEP and HIV/gay stigmas. However, higher order structural-level risks can facilitate or reduce access to PrEP. We propose a structural-ecological model to help visualize multi-level domains of unique stressors that limit the implementation of PrEP among Latinxs. At this stage, the available literature provides little guidance beyond suggesting that culturally adapted interventions can be effective in this population. The model developed here provides that needed specificity regarding targeted interventions that will fit the needs of this population.

Collapse

Cernasev A, Walker C, Kerr C, Barenie RE, Armstrong D, Golden J. Tennessee Pharmacists' Opinions on Barriers and Facilitators to Initiate PrEP: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022;19:ijerph19148431. [PMID: 35886282 PMCID: PMC9323707 DOI: 10.3390/ijerph19148431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]

Faro EZ, Mantell JE, Gonzalez-Argoti T, Hoffman S, Edelstein Z, Tsoi B, Bauman LJ. Implementing PrEP Services in Diverse Health Care Settings. J Acquir Immune Defic Syndr 2022;90:S114-S128. [PMID: 35703763 PMCID: PMC9204802 DOI: 10.1097/qai.0000000000002971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]

Abstract

BACKGROUND

Uptake of pre-exposure prophylaxis (PrEP) in the US has been limited. Evidence for why and how PrEP has been successfully integrated into some clinical settings, but not in others is minimal. To address this gap, we conducted a qualitative study to identify contextual factors that facilitated and challenged the implementation of PrEP services.

SETTING

In partnership with the NYC Department of Health, we convened a planning committee with expertise with groups highly affected by the HIV epidemic employed in diverse health care settings, to guide the project. Representatives from programs within New York were targeted for participation initially and subsequently expanded nationally to enhance diversity in program type.

METHODS

Using an interview guide informed by the Consolidated Framework for Implementation Research, we conducted 20 interviews with participants who successfully implemented PrEP programs in different settings (eg, primary care, emergency department, sexual health clinics), using different delivery models. We used template and matrix analysis to identify and characterize contextual determinants and implementation strategies.

RESULTS

Participants frequently described determinants and strategies fluidly and conceptualized them in context-specific terms. Commonly discussed Consolidated Framework for Implementation Research constructs included implementation climate (tension for change, compatibility, relatively priority), stakeholders' knowledge (or lack thereof) and beliefs about PrEP, and costs associated with PrEP implementation.

CONCLUSION

Our work identifies patterns in PrEP program implementation, describing how organizations dealt with determinants in their own context. Our research points to the need to connect rigorous implementation research with how frontline implementers conceptualize their work to inform and improve PrEP implementation.

Collapse

Calabrese SK, Rao S, Eldahan AI, Tekeste M, Modrakovic D, Dangaran D, Boone CA, Underhill K, Krakower DS, Mayer KH, Hansen NB, Kershaw TS, Magnus M, Betancourt JR, Dovidio JF. "Let's Be a Person to Person and Have a Genuine Conversation": Comparing Perspectives on PrEP and Sexual Health Communication Between Black Sexual Minority Men and Healthcare Providers. ARCHIVES OF SEXUAL BEHAVIOR 2022;51:2583-2601. [PMID: 35790614 PMCID: PMC10040304 DOI: 10.1007/s10508-021-02213-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 06/11/2023]

Abstract

Patient-provider communication is a key factor affecting HIV pre-exposure prophylaxis (PrEP) awareness and access among Black sexual minority men (SMM). Optimizing patient-provider communication requires a deeper understanding of communication dynamics. In this study, we investigated the perspectives of both HIV-negative/status-unknown Black SMM and practicing community healthcare providers regarding patient-provider communication about PrEP and sexual health. We conducted eleven semi-structured qualitative focus groups (six with Black SMM; five with providers) in the Northeastern USA and thematically analyzed transcripts. A total of 36 Black SMM and 27 providers participated in the focus groups. Our analysis revealed points of alignment and divergence in the two groups' perspectives related to patient-provider communication. Points of alignment included: (1) the importance ascribed to maximizing patients' comfort and (2) belief in patients' right to non-discriminatory healthcare. Points of divergence included: (1) Black SMM's preference for sexual privacy versus providers' preference that patients share sexual information, (2) Black SMM's perception that providers have an ethical responsibility to initiate conversations about PrEP with patients versus providers' perception of such conversations as being optional, and (3) Black SMM's preference for personalized sexual health conversations versus providers' preference for standardized conversations. Findings underscore a need for providers to offer more patient-centered sexual healthcare to Black SMM, which should entail routinely presenting all prevention options available-including PrEP-and inviting open dialogue about sex, while also respecting patients' preferences for privacy about their sexuality. This approach could increase PrEP access and improve equity in the US healthcare system.

Collapse

Affiliation(s)

Sarah K Calabrese Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA. Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
Sharanya Rao Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
Adam I Eldahan Columbia School of Nursing, Columbia University, New York, NY, USA
Mehrit Tekeste Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
Djordje Modrakovic Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
D Dangaran Harvard Law School, Harvard University, Cambridge, MA, USA
Cheriko A Boone Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
Kristen Underhill Columbia Law School, Columbia University, New York, NY, USA Heilbrunn Department of Population and Family Health, Columbia University, New York, NY, USA
Douglas S Krakower Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA The Fenway Institute, Fenway Health, Boston, MA, USA Department of Population Medicine, Harvard University, Boston, MA, USA
Kenneth H Mayer Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA The Fenway Institute, Fenway Health, Boston, MA, USA Department of Global Health and Population, Harvard University, Boston, MA, USA
Nathan B Hansen Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
Trace S Kershaw Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
Manya Magnus Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
Joseph R Betancourt Disparities Solution Center, Harvard University, Boston, MA, USA
John F Dovidio Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA Department of Psychology, Yale University, New Haven, CT, USA

Collapse

Liu P, Stewart L, Short WR, Koenig H. Metrics of HIV Pre-exposure Prophylaxis (PrEP) Implementation Before and After a Multidisciplinary Task Force at an Academic Institution. Qual Manag Health Care 2022;31:170-175. [PMID: 35727768 DOI: 10.1097/qmh.0000000000000332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Wiginton JM, Eaton LA, Watson RJ, Maksut JL, Earnshaw VA, Berman M. Sex-Positivity, Medical Mistrust, and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta, Georgia. ARCHIVES OF SEXUAL BEHAVIOR 2022;51:2571-2581. [PMID: 34761347 PMCID: PMC9085967 DOI: 10.1007/s10508-021-02174-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/18/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]

Abstract

Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity's associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α = 0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α = 0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β = 0.19, CI = 0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β = 0.16, CI = 0.02, 0.31) and marginally associated with perceived provider deception (β = 0.14, CI = - 0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM's right to optimal, holistic sexual health.

Collapse