Determinants of familiarity and experience with PrEP in PCP – Survey- 54 from 900 PCPs invited
Concerns about PrEP use, stigma and risk compensation were low, contrasting with earlier reports
Familiarity with PrEP is a key determinant of adoption and correlates with positive perceptions of its effectiveness and simplicity in PrEP guidance and policies in Ontario, Canada
Positive support from leaders and colleagues who endorse PrEP was associated with higher PrEP familiarity and experience among PCPs
Sexual health clinics and primary care settings as suitable venues for PrEP services in contrast to earlier beliefs that HIV specialist settings were best
Providers expressed more concern about unequal access, cost, monitoring, and adherence to PrEP
PCPs with higher familiarity and experience with PrEP are concentrated in specific organizations that served populations likely to seek sexual health services.
Skills in testing, counselling, and managing HIV medications are associated with both familiarity and experience with PrEP
Summary of themes in primary care providers (PCPs) and staff in sexual health clinics (SHC)
Theme 1: Perception of PrEP
Most participants shared positive beleifs about PrEP, they felt PrEP is an important medication that can help keep individuals stay healthy and safe. However, one SHC manager expressed concerns about the inability of individuals to maintain a daily medication regime due to their personal circumstances such as being unhoused while a PCP expressed concerns about PrEP giving individuals a false sense of security.
Regardless of the type of role and setting of practice, participants reported similar perspectives about PrEP being an effective strategy to prevent HIV acquisition. They felt PrEP is an important tool against HIV acquisition if used properly.
Physicians shared their perspectives about possible side effects of PrEP. Specifically, the PCPs described the side effects impacting on PHRA’s willingness to continue the medication when prescribed.
Physicians and SHC managers described their perceptions of PrEP based on their knowledge about PrEP prescription, testing and protocols required before and after administrating the medication.
Theme 2: Implementation of PrEP
Participants described barriers to the implementation of PrEP such as lack of role clarity among staff, staff shortages or reduced staff capacity, limited time for patient follow-up, lack of medical directors, limited local healthcare providers, and rebuilding after the COVID-19 pandemic.
Managers identified other barriers including lack of physicians’ interest in PrEP and view of PrEP as a complicated medication, lack of dedicated sexual health physicians lack of adequate knowledge on PrEP and PrEP program not being a priority within the health unit and lack of PrEP specific training for healthcare providers
The SHC Managers believe they require more staff resources, PrEP specific training for healthcare providers and medical directives to implement PrEP. The PCPs feel additional staff resources are required and this was supported by the SHC managers.
Other resources identified by the SHC Manager and PCPs include PrEP guidelines and policies, dedicated physician support and funding to recruit additional nurses or practitioners
Theme 3: population at risk of HIV and barriers
The PCPs and SHC managers described similar populations they believed were at risk of HIV transmission and willing to use PrEP. These identified groups of people at risk of HIV acquisition are mainly gay and bisexual men, injection drug use population and sex workers
The SHC managers described barriers to PRHAs accessing PrEP including stigma around HIV and the use of PrEP, cost of PrEP and medical insurance processes to acquire the medication, PRHAs’ mental health status and concerns about the side effect of PrEP.
Additionally, the PCPs highlighted other barriers to PRHA accessing PrEP including; PRHAs’inability to start conversations about PrEP and reluctance and concerns about disclose to the PCPs
Theme 4: Partnerships
Participants (PCPs and SHC managers) was described as an important facilitator/barrier for PrEP.
SHC managers noted that there was a limited to no partnership with the government. This was mainly linked to lack of access to funding for additional resources required to implement or prescribe PrEP.
The PCPs supported this view by highlighting the potential benefits of government partnership on PrEP including making it easier for physicians and nurse practitioners to get involved with PrEP
Theme 5: Recommendations
The PCPs and SHC managers suggested
Increasing community awareness on PrEP through the promotion of provincial campaigns.
Providing concise PrEP training for healthcare professionals.
Increasing efforts to eliminate stigma associated with PrEP.
Developing strategies to incentivize PHRA to use PrEP.
Providing education/ information for people on how and where to access prep.
