Online Program

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

Tuesday, November 3, 2015 : 12:30 p.m. - 12:50 p.m.

Sarah K. Calabrese, Ph.D., Yale School of Public Health/ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Manya Magnus, Ph.D., M.P.H., George Washington University Milken Institute School of Public Health, Washington, DC
Kenneth H. Mayer, M.D., Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center/Fenway Community Health, Boston, MA
Douglas Krakower, M.D., Division of Infectious Diseases, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
Adam Eldahan, M.P.H., School of Public Health, Yale University, New Haven, CT
Lauren A. Gaston-Hawkins, B.S., Yale University, New Haven, CT
Nathan B. Hansen, Ph.D., College of Public Health, University of Georgia, Athens, GA
Trace S. Kershaw, Ph.D., Department of Epidemiology and Public Health, Yale University, New Haven, CT
Kristen Underhill, D.Phil., J.D., Yale Law School/ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Joseph Betancourt, M.D., M.P.H., Massachusetts General Hospital, Disparities Solutions Center, Boston, MA
John F. Dovidio, Ph.D., Department of Psychology, Yale University, New Haven, CT
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; Meanage=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.

Learning Areas:

Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Describe healthcare providers’ early experiences with PrEP implementation in clinical practice, including prescribing considerations and logistical challenges.

Keyword(s): HIV/AIDS, Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD and 10+ years of experience conducting research in the realm of HIV prevention. I am the principal investigator of an NIH-funded K01 mixed methods study aimed at promoting PrEP awareness and equitable prescription practices among healthcare providers.
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.