Zhang Chen, Chang Wonkyung, Liu Yu
School of Nursing, University of Rochester Medical Center, Rochester, New York, USA.
Division of Epidemiology, Department of Public Health Science, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA.
AIDS Patient Care STDS. 2025 Feb;39(2):61-69. doi: 10.1089/apc.2024.0241. Epub 2025 Jan 28.
Pre-exposure prophylaxis (PrEP) is an effective strategy in reducing HIV transmission, yet its uptake remains suboptimal. Health care providers play a vital role in facilitating PrEP access and care. This qualitative study explores health care providers' perspectives on the oral PrEP care continuum for adults, emphasizing barriers, facilitators, and missed opportunities in PrEP implementation. Drawing on interviews with 18 primary care providers in New York State, our research investigates multi-level factors influencing PrEP awareness, initiation, and management. Findings reveal significant barriers at the patient level, such as low awareness, stigma, and misconceptions about HIV risk. Provider-level challenges include knowledge gaps, discomfort in discussing sexual health, and logistical constraints. Structural factors such as insufficient infrastructure and high costs impede consistent PrEP management. Facilitators identified include proactive provider-patient communication, educational resources, and workflow integration strategies. Subgroup analyses highlight variations in attitudes based on provider demographics and experience. Younger and female providers are more proactive in discussing PrEP, while older and male providers often perceive it as less relevant. Nurses emphasize patient education and trust-building, contrasting with physicians' focus on logistical challenges. Providers experienced in prescribing PrEP view it as a valuable prevention tool, while nonprescribers report hesitancy and limited familiarity. Discrepancies in patient-perceived versus actual HIV risk, as well as provider assumptions about patient candidacy for PrEP, underscore the need for routine, stigma-free discussions about HIV prevention. This study emphasizes the importance of targeted provider training, system-level support, and inclusive policies to enhance PrEP uptake. Addressing these barriers and leveraging facilitators can advance public health efforts, fostering equitable and effective HIV prevention strategies.
暴露前预防（PrEP）是减少艾滋病毒传播的一项有效策略，但其采用率仍不尽人意。医疗保健提供者在促进PrEP的获取和护理方面发挥着至关重要的作用。这项定性研究探讨了医疗保健提供者对成人口服PrEP护理连续过程的看法，强调了PrEP实施中的障碍、促进因素和错失的机会。通过对纽约州18名初级保健提供者的访谈，我们的研究调查了影响PrEP认知、启动和管理的多层次因素。研究结果揭示了患者层面的重大障碍，如对艾滋病毒风险的认知度低、耻辱感和误解。提供者层面的挑战包括知识差距、讨论性健康时的不适感以及后勤限制。基础设施不足和成本高等结构性因素阻碍了PrEP的持续管理。确定的促进因素包括积极的医患沟通、教育资源和工作流程整合策略。亚组分析突出了基于提供者人口统计学和经验的态度差异。年轻和女性提供者在讨论PrEP方面更积极主动，而年长和男性提供者通常认为其相关性较低。护士强调患者教育和建立信任，这与医生关注后勤挑战形成对比。有开具PrEP处方经验的提供者将其视为一种有价值的预防工具，而非开处方者则表示犹豫且熟悉程度有限。患者感知的与实际的艾滋病毒风险之间的差异，以及提供者对患者PrEP资格的假设，凸显了进行关于艾滋病毒预防的常规、无耻辱感讨论的必要性。本研究强调了有针对性的提供者培训、系统层面的支持和包容性政策对提高PrEP采用率的重要性。解决这些障碍并利用促进因素可以推进公共卫生工作，促进公平有效的艾滋病毒预防策略。
