263811 Challenges for implementing PrEP in clinical settings: Provider perspectives

Wednesday, October 31, 2012 : 10:45 AM - 11:00 AM

Emily Arnold, PhD , Department of Medicine, University of California San Francisco, San Francisco, CA
Patrick Hazelton, MPP , Department of Medicine, University of California San Francisco, San Francisco, CA
Tim Lane, PhD , Department of Medicine, University of California San Francisco, San Francisco, CA
Katerina Christopoulos, MD , Department of Medicine, University of California San Francisco, San Francisco, CA
Gabriel R. Galindo, DrPH, MPH, CHES , Department of Medicine, University of California San Francisco, San Francisco, CA
Stephen Morin, PhD , Department of Medicine, University of California San Francisco, San Francisco, CA
     
Background: A recent clinical trial demonstrated that a daily dose of tenofovir/emtricitabrine can reduce HIV acquisition among men who have sex with men (MSM) and transgendered women by 44%, and up to 90% if taken daily. We explored how medical and service providers understand research results and plan to develop clinical protocols to prescribe, support and monitor adherence for patients on PrEP in the United States. Methods: We conducted in-depth interviews with 22 healthcare providers in San Francisco, Oakland, and Los Angeles from May-December 2011. We analyzed interviews thematically to produce recommendations for setting policy around implementing PrEP. Interview topics included: assessing clinician impressions of PrEP, considerations of cost, office capacity, dosing schedules, and following patients over time. Results: Little or no demand for PrEP from patients was reported. Providers disagreed on who were the most appropriate patients for PrEP and believed that current models of care, which do not involve routine frequent office visits, were not well suited for prescribing PrEP. Providers detailed the need to build capacity (training, referrals, establishing reimbursement levels for care and drugs) and were concerned about monitoring side effects and adherence. PrEP was seen as having impact on the epidemic, but providers also noted that community education campaigns needed to be tailored to effectively reach specific at-risk populations. Conclusions: While PrEP may be a novel and clinically compelling prevention intervention for MSM and transgender women, it raises a number of important implementation challenges that would need to be addressed.

Learning Areas:
Implementation of health education strategies, interventions and programs

Learning Objectives:
Describe four areas where clinicians and service provider experience challenges in implementing PrEP for high-risk patients.

Keywords: HIV Interventions, Providers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the lead investigator on two rapid response studies looking at public policy related to HIV prevention, including the implications of the IPrex Trial results. I am also a principal investigator on two NIH funded studies examining and testing HIV prevention strategies among high risk MSM.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5134.0: Integrated Approaches to HIV Prevention and Treatment