title: HIV providers' perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study.
abstract: Oral pre-exposure prophylaxis (PrEP) can reduce HIV incidence among at-risk persons. However, for PrEP to have an impact in decreasing HIV incidence, clinicians will need to be willing to prescribe PrEP. HIV specialists are experienced in using antiretroviral medications, and could readily provide PrEP, but may not care for HIV-uninfected patients. Six focus groups with 39 Boston area HIV care providers were conducted (May-June 2012) to assess perceived barriers and facilitators to prescribing PrEP. Participants articulated logistical and theoretical barriers, such as concerns about PrEP effectiveness in real-world settings, potential unintended consequences (e.g., risk disinhibition and medication toxicity), and a belief that PrEP provision would be more feasible in primary care clinics. They identified several facilitators to prescribing PrEP, including patient motivation and normative guidelines. Overall, participants reported limited prescribing intentions. Without interventions to address HIV providers' concerns, implementation of PrEP in HIV clinics may be limited.
authors: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St., WLMOB, Suite GB, Boston, MA, 02215, USA, dkrakowe@bidmc.harvard.edu.
authors: Douglas
authors: D
authors: Krakower
authors: Norma
authors: N
authors: Ware
authors: Jennifer A
authors: JA
authors: Mitty
authors: Kevin
authors: K
authors: Maloney
authors: Kenneth H
authors: KH
authors: Mayer
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001900:Boston; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006301:Health Services Needs and Demand; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010465:Perception; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D036301:Qualitative Research; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents