title: Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities.
abstract: Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed.
authors.affiliation: 1 Department of Family Medicine, University of Kansas Medical Center , Kansas City, Kansas.
authors.forename: Sarah
authors.initials: S
authors.lastname: Finocchario-Kessler
authors.affiliation: 2 Health Services and Outcomes Research, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Sofie
authors.initials: S
authors.lastname: Champassak
authors.affiliation: 3 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Hoyt
authors.affiliation: 4 Division of Infectious Diseases, Perelman Schools of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Short
authors.affiliation: 5 Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia .
authors.forename: Rana
authors.initials: R
authors.lastname: Chakraborty
authors.affiliation: 6 HIVE, University of California San Francisco , San Francisco, California.
authors.forename: Shannon
authors.initials: S
authors.lastname: Weber
authors.affiliation: 7 Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, Texas.
authors.forename: Judy
authors.initials: J
authors.lastname: Levison
authors.affiliation: 3 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey.
authors.forename: Joanne
authors.initials: J
authors.lastname: Phillips
authors.affiliation: 3 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey.
authors.forename: Deborah
authors.initials: D
authors.lastname: Storm
authors.affiliation: 8 Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions , Baltimore, Maryland.
authors.forename: Jean
authors.initials: J
authors.lastname: Anderson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D002947:Cities; D003267:Contraception / Q000379:methods* / Q000523:psychology; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D006679:HIV Seropositivity / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010465:Perception; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D036301:Qualitative Research; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D019380:Anti-HIV Agents