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Engaging healthcare providers to implement HIV pre-exposure prophylaxis

Krakower, Douglasa,b; Mayer, Kenneth H.a,b,c

doi: 10.1097/COH.0b013e3283590446
PRE-EXPOSURE PROPHYLAXIS: Edited by Kenneth H Mayer

Purpose of review: Recent randomized controlled trials have demonstrated that HIV pre-exposure prophylaxis (PrEP) can decrease HIV incidence among several at-risk populations, including men who have sex with men, serodiscordant couples, and heterosexual men and women. As PrEP is a biomedical intervention that requires clinical monitoring and a high level of medication adherence, maximizing the public health effectiveness of PrEP in real-world settings will require the training of a cadre of healthcare providers to prescribe PrEP. Therefore it is critical to understand provider knowledge, practices, and attitudes towards PrEP prescribing, and to develop strategies for engaging and training providers to provide PrEP.

Recent findings: Limited numbers of studies have focused on PrEP implementation by healthcare providers. These studies suggest that some providers are knowledgeable about PrEP, but many are not, or express misgivings. Although many clinicians report willingness to provide PrEP, few have prescribed PrEP in clinical practice. Provider comfort and skills in HIV risk assessment are suboptimal, which could limit identification of individuals who are most likely to benefit from PrEP use.

Summary: Further studies to understand facilitators and barriers to HIV-risk assessment and PrEP prescribing by practicing clinicians are needed. Innovative training strategies and decision-support interventions for providers could optimize PrEP implementation and therefore merit additional research.

aDivision of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center

bHarvard Medical School

cThe Fenway Institute, Fenway Health, Boston, Massachusetts, USA

Correspondence to Kenneth H. Mayer, MD, Fenway Health, 1340 Boylston St, Boston, MA 02215, USA. Tel: +1 617 927 6087; fax: +1 617 267 0764; e-mail: kmayer@fenwayhealth.org

© 2012 Lippincott Williams & Wilkins, Inc.