PC4PrEP Administrative Supplement:
Decision-Making around PrEP among Providers in Different Practice Setting
National Institute of Mental Health (NIMH)
Bronx, NY, USA
Uptake of oral HIV pre-exposure prophylaxis (PrEP) has been limited since it was approved by the FDA in 2012. Ambiguity about where and how PrEP should be delivered, with no one medical specialty taking prescribing responsibility, has slowed translation to real-world PrEP roll-out. A high research priority should be to develop and test approaches to integrating PrEP into service delivery settings. There is a large grey area in deciding who should receive PrEP. CDC and clinical practice guidelines recommend oral PrEP for men who have sex with men and transgender individuals who have sex with men, but not all individuals in these categories are at substantial risk of HIV infection, and clinicians therefore make decisions about PrEP eligibility using non-medical criteria.
Collaborating with the New York City Department of Health and Mental Hygiene’s (NYC DOHMH) Project PrIDE, which will help support the integration of PrEP navigation into STD Clinics, we are conducting a mixed-methods study in which qualitative interviews with 40 STD medical providers explore their professional decision-making process about PrEP, identify criteria used to decide whether to prescribe PrEP, and assess changes in these criteria over time. Coded interview will be combined with NYC DOHMH electronic medical record data on STD clinic patients to assess the role of patient, provider, and clinic factors on actual PrEP-prescribing practices. In Year 2, we will conduct qualitative interviews with 18 PrEP-prescribing providers in the NYC DOHMH-supported PlaySure Network who accept referrals for PrEP from a variety of entities, including NYC DOHMH STD providers, to better understand challenges faced in maintaining patients on PrEP and decision-making about continuing the PrEP regimen. We will interview 30 key informants and stakeholders to assess the feasibility and utility of assessing PrEP eligibility in Emergency Departments and Urgent Care Centers and linking patients to providers in NYC DOHMH-supported PlaySure Network. We will also establish a “Community of Practice” (CoP) website with two goals: to assess the feasibility and acceptability of a CoP to resolve PrEP-prescribing and management dilemmas, and to use the data from the CoP to describe decision-making among PrEP providers.