Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services.

Published on Oct 1, 2021in Journal of Acquired Immune Deficiency Syndromes3.475
· DOI :10.1097/QAI.0000000000002750
Shawnika J. Hull12
Estimated H-index: 12
(GW: George Washington University),
Hanna Tessema (GW: George Washington University)+ 1 AuthorsRachel K. Scott2
Estimated H-index: 2
(MedStar Washington Hospital Center)
Source
Abstract
BACKGROUND Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice. SETTING We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties. METHOD Providers received 1 of 4 vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness to prescribe PrEP to her. RESULTS We tested 2 models predicting providers (1) willingness to discuss and (2) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients' abilities to adhere to PrEP, but not their expectations of risk compensatory behaviors. CONCLUSIONS Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.
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#3Jeffrey Wiener (CDC: Centers for Disease Control and Prevention)H-Index: 18
Last. Cyprian Wejnert (CDC: Centers for Disease Control and Prevention)H-Index: 25
view all 6 authors...
The number of new HIV diagnoses is highest in the South. Many persons who might benefit from pre-exposure prophylaxis (PrEP) are not engaged in the HIV PrEP continuum of care. We analyzed National HIV Behavioral Surveillance data to assess engagement in the PrEP continuum of care among persons with increased HIV risk. We compared PrEP awareness, discussion with a clinical provider, and use among persons living in the South to those living elsewhere in the United States. PrEP awareness was lowest...
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#1Mehrit Tekeste (GW: George Washington University)H-Index: 4
#2Shawnika J. Hull (GW: George Washington University)H-Index: 12
Last. Sarah K. Calabrese (GW: George Washington University)H-Index: 26
view all 11 authors...
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention method. PrEP uptake has been persistently low among US women, particularly Black women, who account for 61% of new HIV diagnoses among women. Further understanding of barriers to Black women accessing PrEP is needed. This 2017 cross-sectional survey study explored race-based differences in PrEP interest and intention among women and the indirect association between race and comfort discussing PrEP with a healthcare provide...
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: Incident human immunodeficiency virus (HIV) infections among adolescent females and women declined during 2010-2016, with the largest decrease (21%) occurring among black women (1). However, in 2016, although black women accounted for 13% of the U.S. female population, 60% of new HIV infections among women were in black women, indicating persisting disparities (1). CDC used the population attributable proportion (PAP) disparity measure to describe the proportional decrease in HIV infection amo...
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#1Anar S. Patel (Emory University)H-Index: 3
#2Lakshmi Goparaju (Georgetown University)H-Index: 13
Last. Anandi N. Sheth (Emory University)H-Index: 16
view all 16 authors...
Background:Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, off
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#1Gaukhar MergenovaH-Index: 4
#2Nabila El-Bassel (Columbia University)H-Index: 5
Last. Susan S. Witte (Columbia University)H-Index: 24
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Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementati...
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#1Aaron J Siegler (Emory University)H-Index: 23
#2Farah Mouhanna (Emory University)H-Index: 7
Last. Patrick S. Sullivan (Emory University)H-Index: 79
view all 12 authors...
Abstract Purpose The number of individuals who have started a regimen for HIV pre-exposure prophylaxis (PrEP) in the United States is not well characterized but has been on the rise since 2012. This analysis assesses the distribution of PrEP use nationally and among subgroups. Methods A validated algorithm quantifying tenofovir disoproxil fumarate/emtricitabine for PrEP in the United States was applied to a national prescription database to determine the quarterly prevalence of PrEP use. HIV dia...
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#1Bisola O. Ojikutu (Harvard University)H-Index: 19
#2Laura M. Bogart (AN: RAND Corporation)H-Index: 63
Last. Kenneth H. MayerH-Index: 134
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This study explores willingness to use PrEP among Black individuals in the US. From February to April 2016, an online survey was administered to a nationally representative sample of Black individuals. 855 individuals who were HIV negative by self-report participated [mean age: 33.6 (SD 9.2); 45.5% male]. Among all respondents, 14.5% were aware of, and 26.0% would be willing to use PrEP. Among high-risk individuals (N = 327), 19.8% knew about and 35.1% would be willing to use PrEP. The most comm...
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#1Sarah K. Calabrese (Yale University)H-Index: 26
#2Valerie A. Earnshaw (UD: University of Delaware)H-Index: 35
Last. John F. Dovidio (Yale University)H-Index: 126
view all 11 authors...
Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and backgro...
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#1Sarah K. Calabrese (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 26
#2Douglas S. Krakower (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 30
Last. Kenneth H. Mayer (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 134
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More than 3 decades since its emergence in the United States, HIV continues to spread and disproportionately affect socially marginalized groups.Preexposure prophylaxis (PrEP), a highly effective prevention strategy federally approved since 2012, could fundamentally alter the course of the epidemic. However, PrEP’s potential has not been fully realized, in part because health care providers have been slow to adopt PrEP in clinical practice and have been selective in their discussion of PrEP with...
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#1Lakshmi Goparaju (UW: University of Washington)H-Index: 2
#2Nathan C Praschan (Georgetown University)H-Index: 2
Last. Seble Kassaye (Georgetown University)H-Index: 18
view all 6 authors...
Background: Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP. Methods: Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area. Results: The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to ...
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