Title : Perspectives of OBGYN clinicians on integrating PrEP in routine women’s health care: A qualitative analysis
Abstract:
Background: Human Immunodeficiency Virus (HIV) continues to be a major public health problem in the United States. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but uptake remains low, especially among women. Furthermore, HIV prevention in pregnant individuals provides protection for both the mother and fetus. Research demonstrates OBGYN providers play an important role in HIV prevention care, but OBGYN perspectives around this have not been surveyed.
Methods: We conducted qualitative interviews with OBGYN providers, medical directors, and PrEP navigators in 2 academic OBGYN clinics in Philadelphia to understand facilitators and barriers for PrEP uptake among cisgender women.
Results: We completed 16 interviews: 12 physicians, 2 PrEP navigators, and 2 Advanced Practice Providers. Participants were mostly female (88%). The most common barriers identified included 1) decreased risk perception (provider for the individual or the individual for themselves) 2) Provider inexperience with PrEP 3) Provider discomfort with prescribing and monitoring individuals on PrEP 4) Lack of a streamlined workflow for PrEP 5) Time and personnel limitations and 6) HIV stigma. Facilitators included 1) a strong desire to provide HIV preventative care services 2) an interdisciplinary care team including pharmacists, PrEP navigators, and social workers and 3) Having an infectious diseases expert liaison. Participants suggested education, improvements in workflow, and utilizing the electronic medical record (EMR) for HIV screening and PrEP care.
Conclusions: Understanding barriers and facilitators can help guide implementation of PrEP strategies in the OBGYN setting. Our study demonstrates OBGYN providers view HIV prevention within their scope of practice, however there are key clinic infrastructure and personnel limitations to provide this care. We highlight interdisciplinary teams as a facilitator for this work. Participant feedback suggests care can be improved through a multifactorial intervention including PrEP education, utilizing the EMR for prompts for screening and monitoring, team-based care, and a clear workflow.
