April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Identifying Provider-Level Barriers to Provision of PrEP Services for Cisgender Women
Background. HIV pre-exposure prophylaxis (PrEP) is effective for prevention of HIV in cisgender women (Baeten et al., 2012; Delany-Moretlwe et al., 2022; Murnane et al., 2013; Thigpen et al., 2012), but underutilized by women with indications for it (Centers for Disease Control and Prevention, 2021). Provider-level barriers contribute to this underutilization (Bradley et al., 2019; Bradley & Hoover, 2019; Caplon et al., 2021; Collier et al., 2017; Hull et al., 2021; Seidman et al., 2016), but barriers specific to provision for women are not well elucidated in the literature, most of which is several years old in a rapidly evolving field of pharmacoprevention. We hypothesized that provider-level barriers to provision of PrEP services to women in the primary care setting contribute to PrEP underutilization in this population. We sought to identify specific communication barriers to PrEP provision. We consider a provider’s willingness to discuss PrEP with women as an act that has many commonalities with HIV status disclosure, because HIV stigma creates barriers to HIV prevention and PrEP conversations (Chittamuru et al., 2020; Geary & Bukusi, 2014; Goparaju et al., 2017; Hull et al., 2021; Teitelman et al., 2020). Furthermore, evidence demonstrates that the majority of women who may be eligible for PrEP are not using it and are largely unaware of it (Goparaju et al., 2015; Johnson et al., 2020). Thus, for many providers, initiating discussion of PrEP involves a complex set of sensitive disclosures.
Methods. We recruited primary care physicians caring for women in high-HIV prevalence regions in the US (N =21). Internal medicine, family medicine, obstetrics and gynecology (OB/GYN), and infectious disease (ID) physicians were eligible to participate. We conducted semi-structured interviews focusing on their experiences with provision of PrEP services to female patients. Interviews were conducted by two trained research team members. The researchers created a codebook using an adapted Disclosure Decision-Making Model. Using Dedoose, the research team achieved acceptable inter-coder reliability (kappa = 0.85) double coding three interviews. Interviews were coded and analyzed to describe themes.
Results. One interview was excluded due to lack of analyzable data. 20 interviews were coded with three internal medicine, three family medicine, ten OB/GYN, and four ID physicians. Providers identified barriers to provision of PrEP to women including perceived low patient awareness of and knowledge about PrEP, discomfort discussing PrEP, lack of provider training, HIV stigma, and concern about patient adherence to PrEP. Provider-identified facilitators of provision included good physician-patient relationships, continuity of care, and patient initiation of PrEP discussions.
Conclusions. We applied the DDMM to describe the factors that shape providers’ decisions to disclose information about PrEP to women. We describe the factors that shape information and recipient assessments, as well as efficacy of disclosure, which shape the decision to enact message strategies or activate a third-party alternative. In this context, the clinical recommendation assessment as also an important consideration for providers in the decision to enact message strategies. These findings point to potential avenues for communication interventions to increase engagement in the PrEP cascade among women.
Methods. We recruited primary care physicians caring for women in high-HIV prevalence regions in the US (N =21). Internal medicine, family medicine, obstetrics and gynecology (OB/GYN), and infectious disease (ID) physicians were eligible to participate. We conducted semi-structured interviews focusing on their experiences with provision of PrEP services to female patients. Interviews were conducted by two trained research team members. The researchers created a codebook using an adapted Disclosure Decision-Making Model. Using Dedoose, the research team achieved acceptable inter-coder reliability (kappa = 0.85) double coding three interviews. Interviews were coded and analyzed to describe themes.
Results. One interview was excluded due to lack of analyzable data. 20 interviews were coded with three internal medicine, three family medicine, ten OB/GYN, and four ID physicians. Providers identified barriers to provision of PrEP to women including perceived low patient awareness of and knowledge about PrEP, discomfort discussing PrEP, lack of provider training, HIV stigma, and concern about patient adherence to PrEP. Provider-identified facilitators of provision included good physician-patient relationships, continuity of care, and patient initiation of PrEP discussions.
Conclusions. We applied the DDMM to describe the factors that shape providers’ decisions to disclose information about PrEP to women. We describe the factors that shape information and recipient assessments, as well as efficacy of disclosure, which shape the decision to enact message strategies or activate a third-party alternative. In this context, the clinical recommendation assessment as also an important consideration for providers in the decision to enact message strategies. These findings point to potential avenues for communication interventions to increase engagement in the PrEP cascade among women.