Provider confidence in PrEP initiation associated with PrEP knowledge and attitudes

November 04, 2022

3 minute read


Source/Disclosures


Disclosures: The authors report no relevant financial information.


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According to survey results, provider confidence in initiating PrEP, which was generally lower than other aspects of PrEP care, was associated with provider knowledge of PrEP and attitudes supportive of PrEP.

“HIV PrEP is an effective HIV prevention drug that was first approved in the United States 10 years ago, but uptake is still quite low among cisgender women in the United States, particularly in the South, which is the epicenter of the national HIV epidemic”, Aditi Ramakrishnan, MD, MSc, assistant professor of medicine at Washington University at St. Louis School of Medicine, Healio said. “Some of the challenges in scaling up PrEP for cisgender women include the paucity of clinics providing PrEP, lack of insurance support for PrEP, and lack of provider training in PrEP care.”



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Trainings focused on PrEP initiation may be more effective in filling gaps in provider PrEP training, Aditi Ramakrishnan, MD, M.Sc., told Healio, after reviewing survey results suggesting the association between knowledge and attitudes surrounding PrEP and PrEP initiation. Source: Adobe Stock.

According to Ramakrishnan, Title X-funded family planning clinics serve as a health care safety net for women of childbearing age, particularly in the South, and are therefore potential sites for PrEP delivery.

“In order to effectively implement PrEP care in this new setting, one needs to understand the training needs of providers,” she said. “We conducted this study to assess knowledge, attitudes, and self-efficacy (i.e., confidence in performing steps) in PrEP care among providers of funded family planning clinics. by Title X who did not provide PrEP in 18 Southern states to inform provider education on PrEP care.

Ramakrishnan and his colleagues used data from providers at clinics not currently providing PrEP from an online survey administered to Title X clinic staff in southern states between February and June 2018.

According to the study, they then developed generalized linear mixed models to assess associations between provider-, clinic-, and county-level variables with provider knowledge, attitudes, and self-efficacy in health care. Prep.

Overall, 519 providers and administrators from 283 clinics responded to the survey. After excluding responses from administrators and clinics offering PrEP, 351 providers from 193 non-PrEP clinics were included in this secondary analysis, including 194 nonprescribing providers and 157 prescribing providers.

In the adjusted global model, knowledge of PrEP was positively associated with ability to prescribe (0.851; 95% CI, 0.493-1.209) and negatively associated with years worked in a clinical role (-0.031; 95% CI, -0.053 to -0.010). Among nonprescribing providers, there was a significant negative association with years worked in a clinical role (-0.038; 95% CI, -0.078 to -0.010), while among prescribing providers, there was no significant covariate associations.

The mean attitude score was 3.52 and higher for prescribing providers compared to non-prescribing providers (P did not differ by prescriber status.

The researchers found, however, that for the subcategory of clinical and sociobehavioral attitudes toward PrEP, prescribing providers had more favorable attitudes than non-prescribing providers (P

In the adjusted global model, PrEP attitudes were positively associated with the ability to prescribe (0.192; 95% CI, 0.071-0.313), and among non-prescribing providers there were significant positive associations with on-site insurance assistance (0.180; 95% CI, 0.021-0.340) and HIV prevalence by county (0.095; 95% CI, 0.004-0.186).

Aditi Ramakrishnan, MD, M.Sc.

The mean overall self-efficacy score was 3.4 and was higher for prescribing providers than for non-prescribing providers (P P .0001). Comparison of scores across stages indicated that prescribing and nonprescribing providers were the most confident in PrEP screening, least confident in PrEP follow-up, and least confident in PrEP initiation (P

They also found that self-efficacy in PrEP care was positively associated with prescribing ability (0.424; 95% CI, 0.290-0.559), attitudes towards PrEP (0.213; 95% CI, 0.094- 0.332), contraceptive self-efficacy (0.439; 95% CI, 0.367-0.511) and negatively associated with the county’s percentage of Hispanics/Latinos in the population (-0.089; 95% CI, -0.162 to -0.017).

“In addition to important structural factors such as Medicaid expansion and support for Title X-funded clinics, for clinics to transition to providing PrEP, providers must be equipped with tailored training,” said Ramakrishnan. “Trainings that focus on PrEP initiation, especially PrEP drug assistance/insurance, attitudes toward PrEP care, and integration of PrEP training and family planning may be more effective to address gaps in provider training.”

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