title: A Clinical Home for Preexposure Prophylaxis: Diverse Health Care Providers' Perspectives on the "Purview Paradox".
abstract: BACKGROUND
  One barrier to wider preexposure prophylaxis (PrEP) availability is uncertainty about the most appropriate providers and practice settings for offering PrEP.
  
  
  METHODS
  The authors conducted in-depth interviews with 30 clinicians--primary care and HIV specialists--in the New York City (NYC) region to explore issues related to PrEP rollout, including who should provide it and in what settings.
  
  
  RESULTS
  A diverse group favored offering PrEP in non-HIV specialty settings in order to reach high-risk HIV-negative individuals. Yet, for each clinical skill or ancillary service deemed important for providing PrEP--knowledge of the medications, ability to assess and counsel around sexual risk behavior, and ability to provide support for retention and medication adherence--participants were divided in whether they thought primary care providers/practices could achieve it. Five participants strongly favored providing PrEP in HIV care practices.
  
  
  CONCLUSIONS
  Although there may be multiple "homes" for PrEP, implementation research is needed to identify the most effective delivery approaches.
authors: Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA sh51@cumc.columbia.edu.
authors: Susie
authors: S
authors: Hoffman
authors: Gay Men's Health Crisis (GMHC) and SAE & Associates, New York, NY, USA.
authors: John A
authors: JA
authors: Guidry
authors: Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
authors: Kate L
authors: KL
authors: Collier
authors: Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
authors: Joanne E
authors: JE
authors: Mantell
authors: Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors: Daria
authors: D
authors: Boccher-Lattimore
authors: Visiting Assistant Professor of Psychology, Bard College, Annandale-on-Hudson, NY, USA.
authors: Farnaz
authors: F
authors: Kaighobadi
authors: Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors: Theo G M
authors: TG
authors: Sandfort
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D004493:Education; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009519:New York City; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D012309:Risk-Taking; D000078329:Workforce
chemical_list: D019380:Anti-HIV Agents
keywords: biomedical HIV prevention; health care provider; implementation; preexposure prophylaxis (PrEP)