Putting PrEP into practice: PrEP providers' first-hand experiences, challenges, and solutions

Background: Optimizing access to pre-exposure prophylaxis (PrEP), an essential new tool for HIV prevention, requires supporting healthcare providers’ adoption of PrEP into clinical practice. This qualitative study explored PrEP providers’ first-hand experiences with PrEP initiation and clinical management. 

Methods: U.S.-based PrEP providers were recruited via referral from colleagues and other participants (September 2014-February 2015). One-on-one, 90-minute interviews were conducted via phone or in person, transcribed, and analyzed.

Results: The sample (n=18; Mean_age=43; 72% men) was diverse with respect to race (39% White/33% Asian/11% Black/17% Other), sexual orientation (56% heterosexual/44% gay), and geographic location (67% Northeast/22% South/11% other). Most were MDs (94%) and self-identified as HIV or infectious disease specialists (89%). Prior experience prescribing PrEP ranged from 2-300 patients, with many patients characterized as MSM. Providers reported considering several factors beyond CDC criteria in determining eligibility for PrEP, including local HIV epidemiology, PrEP’s potential psychosocial benefits, and patients’ underreporting of risk behavior. PrEP initiation was commonly decided using a collaborative, patient-centered approach. Providers observed that PrEP was well tolerated among most patients, with minimal adherence difficulties, increases in risk behavior, or adverse effects. Several providers highlighted the benefit of clinical staff support for patient monitoring and risk/adherence counseling. PrEP was covered for most patients via insurance, Medicaid, or other programs; however, high deductibles, lab work/service provision costs, and pre-authorization requirements sometimes presented challenges.

Conclusions: Overall, providers reported favorable experiences with PrEP initiation and management. Reported insights may be instructive for providers who are less familiar with PrEP, thereby supporting patient access.