Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training

There is growing evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition. However, in the United States, approximately only 4% of people who could benefit from PrEP are currently receiving it, and it is estimated only 1 in 5 physicians has ever prescribed PrEP. We conducted a scoping...

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Main Authors: Robert L. Cooper PhD, MSSW, Paul D. Juarez PhD, Matthew C. Morris PhD, Aramandla Ramesh PhD, Ryan Edgerton MPH, Lauren L. Brown PhD, LCSW, MSSW, Leandro Mena MD, Samuel A. MacMaster PhD, Shavonne Collins MD, Patricia Matthews- Juarez PhD, Mohammad Tabatabai PhD, Katherine Y. Brown EdD, Michael J. Paul MPH, Wansoo Im PhD, Thomas A. Arcury PhD, Marybeth Shinn PhD
Format: Article
Language:English
Published: SAGE Publishing 2021-05-01
Series:Inquiry: The Journal of Health Care Organization, Provision, and Financing
Online Access:https://doi.org/10.1177/00469580211017666
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author Robert L. Cooper PhD, MSSW
Paul D. Juarez PhD
Matthew C. Morris PhD
Aramandla Ramesh PhD
Ryan Edgerton MPH
Lauren L. Brown PhD, LCSW, MSSW
Leandro Mena MD
Samuel A. MacMaster PhD
Shavonne Collins MD
Patricia Matthews- Juarez PhD
Mohammad Tabatabai PhD
Katherine Y. Brown EdD
Michael J. Paul MPH
Wansoo Im PhD
Thomas A. Arcury PhD
Marybeth Shinn PhD
author_facet Robert L. Cooper PhD, MSSW
Paul D. Juarez PhD
Matthew C. Morris PhD
Aramandla Ramesh PhD
Ryan Edgerton MPH
Lauren L. Brown PhD, LCSW, MSSW
Leandro Mena MD
Samuel A. MacMaster PhD
Shavonne Collins MD
Patricia Matthews- Juarez PhD
Mohammad Tabatabai PhD
Katherine Y. Brown EdD
Michael J. Paul MPH
Wansoo Im PhD
Thomas A. Arcury PhD
Marybeth Shinn PhD
author_sort Robert L. Cooper PhD, MSSW
collection DOAJ
description There is growing evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition. However, in the United States, approximately only 4% of people who could benefit from PrEP are currently receiving it, and it is estimated only 1 in 5 physicians has ever prescribed PrEP. We conducted a scoping review to gain an understanding of physician-identified barriers to PrEP provision. Four overarching barriers presented in the literature: Purview Paradox, Patient Financial Constraints, Risk Compensation, and Concern for ART Resistance. Considering the physician-identified barriers, we make recommendations for how physicians and students may work to increase PrEP knowledge and competence along each stage of the PrEP cascade. We recommend adopting HIV risk assessment as a standard of care, improving physician ability to identify PrEP candidates, improving physician interest and ability in encouraging PrEP uptake, and increasing utilization of continuous care management to ensure retention and adherence to PrEP.
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spelling doaj.art-40c4de7970be495c9e72687bd5d2ac892022-12-21T18:45:37ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432021-05-015810.1177/00469580211017666Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student TrainingRobert L. Cooper PhD, MSSW0Paul D. Juarez PhD1Matthew C. Morris PhD2Aramandla Ramesh PhD3Ryan Edgerton MPH4Lauren L. Brown PhD, LCSW, MSSW5Leandro Mena MD6Samuel A. MacMaster PhD7Shavonne Collins MD8Patricia Matthews- Juarez PhD9Mohammad Tabatabai PhD10Katherine Y. Brown EdD11Michael J. Paul MPH12Wansoo Im PhD13Thomas A. Arcury PhD14Marybeth Shinn PhD15Meharry Medical College, Nashville, TN, USAMeharry Medical College, Nashville, TN, USAUniversity of Mississippi Medical Center, Jackson, MS, USAMeharry Medical College, Nashville, TN, USAMeharry Medical College, Nashville, TN, USABehavioral Health & Research at Nashville Cares, Nashville, TN, USAUniversity of Mississippi Medical Center, Jackson, MS, USABaylor College of Medicine in Houston, Houston, TX, USAMeharry Medical College, Nashville, TN, USAMeharry Medical College, Nashville, TN, USAMeharry Medical College, Nashville, TN, USAMeharry Medical College, Nashville, TN, USAMeharry Medical College, Nashville, TN, USAMeharry Medical College, Nashville, TN, USAWake Forest School of Medicine, Winston-Salem, NC, USAVanderbilt University, Nashville, TN, USAThere is growing evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition. However, in the United States, approximately only 4% of people who could benefit from PrEP are currently receiving it, and it is estimated only 1 in 5 physicians has ever prescribed PrEP. We conducted a scoping review to gain an understanding of physician-identified barriers to PrEP provision. Four overarching barriers presented in the literature: Purview Paradox, Patient Financial Constraints, Risk Compensation, and Concern for ART Resistance. Considering the physician-identified barriers, we make recommendations for how physicians and students may work to increase PrEP knowledge and competence along each stage of the PrEP cascade. We recommend adopting HIV risk assessment as a standard of care, improving physician ability to identify PrEP candidates, improving physician interest and ability in encouraging PrEP uptake, and increasing utilization of continuous care management to ensure retention and adherence to PrEP.https://doi.org/10.1177/00469580211017666
spellingShingle Robert L. Cooper PhD, MSSW
Paul D. Juarez PhD
Matthew C. Morris PhD
Aramandla Ramesh PhD
Ryan Edgerton MPH
Lauren L. Brown PhD, LCSW, MSSW
Leandro Mena MD
Samuel A. MacMaster PhD
Shavonne Collins MD
Patricia Matthews- Juarez PhD
Mohammad Tabatabai PhD
Katherine Y. Brown EdD
Michael J. Paul MPH
Wansoo Im PhD
Thomas A. Arcury PhD
Marybeth Shinn PhD
Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training
Inquiry: The Journal of Health Care Organization, Provision, and Financing
title Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training
title_full Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training
title_fullStr Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training
title_full_unstemmed Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training
title_short Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training
title_sort recommendations for increasing physician provision of pre exposure prophylaxis implications for medical student training
url https://doi.org/10.1177/00469580211017666
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