Khosropour Christine M, Healy Elise, Murphy Emma M, Means Arianna Rubin, Pasha Erykah, Howard Jaelyn, Gonzalez Emani, Lloyd Tiffany D, Spier Bethany, Berry Cathy J, Backus Kandis V
Department of Epidemiology, University of Washington, Seattle, WA, United States.
Department of Medicine, University of Washington, Seattle, WA, United States.
Front Health Serv. 2025 May 30;5:1567688. doi: 10.3389/frhs.2025.1567688. eCollection 2025.
HIV pre-exposure prophylaxis (PrEP) is effective at preventing HIV but uptake among cisgender women in the United States (US) is suboptimal. Most US cisgender women receive care in private practice settings, but PrEP has not been routinely integrated there. We investigated barriers and facilitators to integrating PrEP into women's health practices.
In upstate New York in 2023, we conducted two focus group discussions (FGDs) with 22 cisgender women of color. Discussions focused on patient awareness/knowledge of PrEP, experiences accessing sexual healthcare, and preferences in services offered. We concurrently conducted one-on-one in-depth interviews (IDI) with 11 clinical staff (medical assistants, nurses, physicians/midwives) in an obstetrics/gynecology private practice. Interviews focused on staff awareness/knowledge of PrEP, desire to offer PrEP, and barriers/facilitators to integrating PrEP into practice flow. Thematic analysis, informed by the COM-B and Theoretical Domains Framework, was used to identify determinants of integration.
The median age of FGD participants was 20 and 72% identified as Black. Key themes included: low awareness of and misconceptions about PrEP (e.g., PrEP is for gay men); perceived stigma about PrEP (e.g., PrEP implies multiple sexual partnerships); previous negative experiences seeking medical care (e.g., feeling judged); desire for healthcare settings to integrate PrEP as part of holistic reproductive healthcare. Clinical staff had low awareness of and misconceptions about PrEP. Barriers to integrating PrEP included: lack of PrEP knowledge, lack of time to integrate PrEP services within routine visits, challenges with billing insurance for integrated services, and heterogeneity in comfort with sexual health discussions with patients. Facilitators included staff buy-in to provide PrEP and willingness to adapt clinical protocols to integrate PrEP, rooted in recognition that HIV prevention is important for their patients and community.
Similar misconceptions about PrEP exist among cisgender women in the community and clinical providers in private practice, but both groups recognize the importance of expanding PrEP access. Despite high motivation to prescribe PrEP, there are unique structural barriers to integrating PrEP in the private practice setting (e.g., insurance and billing). Directly addressing shared and distinct patient and provider-level concerns may facilitate integration of PrEP services in private practices.
HIV暴露前预防（PrEP）在预防HIV方面有效，但美国顺性别女性对其的接受程度并不理想。大多数美国顺性别女性在私人诊所接受护理，但PrEP尚未在那里常规整合。我们调查了将PrEP整合到女性健康实践中的障碍和促进因素。
2023年在纽约州北部，我们与22名有色人种顺性别女性进行了两次焦点小组讨论（FGD）。讨论集中在患者对PrEP的认识/了解、获得性健康护理的经历以及对所提供服务的偏好。我们同时对一家妇产科私人诊所的11名临床工作人员（医疗助理、护士、医生/助产士）进行了一对一的深入访谈（IDI）。访谈集中在工作人员对PrEP的认识/了解、提供PrEP的意愿以及将PrEP整合到实践流程中的障碍/促进因素。采用基于COM - B和理论领域框架的主题分析来确定整合的决定因素。
焦点小组讨论参与者的中位年龄为20岁，72%的人认定为黑人。关键主题包括：对PrEP的认识不足和误解（例如，PrEP是给男同性恋者用的）；对PrEP的耻辱感（例如，PrEP意味着多个性伴侣）；以前寻求医疗护理的负面经历（例如，感觉被评判）；希望医疗机构将PrEP作为整体生殖健康护理的一部分进行整合。临床工作人员对PrEP的认识不足且存在误解。整合PrEP的障碍包括：缺乏PrEP知识、在常规就诊中缺乏将PrEP服务整合进去的时间、综合服务的保险计费方面的挑战以及与患者进行性健康讨论时的舒适度差异。促进因素包括工作人员支持提供PrEP并愿意调整临床方案以整合PrEP，这源于认识到HIV预防对他们的患者和社区很重要。
社区中的顺性别女性和私人诊所的临床提供者对PrEP存在类似的误解，但两组都认识到扩大PrEP获取途径的重要性。尽管有很高的开具PrEP处方的积极性，但在私人诊所环境中整合PrEP存在独特的结构性障碍（例如，保险和计费）。直接解决患者和提供者层面共同的和不同的担忧可能会促进PrEP服务在私人诊所中的整合。
