Provider-Patient Communication on Pre-Exposure Prophylaxis (Prep) for HIV Prevention: An Exploration of Healthcare Provider Challenges.

Pre-exposure prophylaxis (PrEP) is a once-daily pill prescribed by healthcare providers to protect patients from contracting HIV. Current data suggests that a minority of healthcare providers have ever prescribed it to clinically-eligible patients. The present study employed a social ecological framework to understand the factors that influence providers' engagement in patient-centered communication regarding PrEP. Semi-structured interviews (N = 20) with physicians, physician assistants, and nurse practitioners working in primary and specialty care practices in Western New York were thematically analyzed to understand provider-based PrEP communication challenges. Although participants never prescribed PrEP, all had clinical experience with patient populations at risk for HIV, such as people who inject drugs, men who have sex with men, transgender women, and people who exchange sex for resources. Results revealed three themes affecting provider engagement in PrEP-related discussions, which emerged across three levels of the social ecological model. At the individual level, challenges affecting provider engagement in patient-centered discussions included lacking PrEP knowledge to educate and counsel patients and discomfort with prescribing PrEP based on its perceived newness. At the interpersonal level, participants expressed varying degrees of discomfort discussing HIV risk behaviors with patients. At the organizational level, providers expressed that time constraints and managing concurrent health conditions were competing clinical priorities. Findings indicate expanding implementation efforts will require multilevel interventions that target potential PrEP-adopting healthcare providers to mitigate the perceived and real challenges surrounding provider-patient communication on PrEP for HIV prevention. Practical implications are discussed.