Examining Perceptions Among Healthcare Providers on Their Awareness of and Experience with Prescribing and/or Referring Pre-Exposure Prophylaxis to Eligible Cisgender Black Female Patients: A Qualitative Inquiry
Abstract
1. Introduction
2. Materials and Methods
Data Analysis
3. Results
3.1. Self-Awareness
3.1.1. Provider Awareness of PrEP Facilitators
I think one of the first things that I think about is the level of communication. So, if as the patient, they don’t feel comfortable talking to their provider about it, then how can we ever know that they need it? And so, I think it goes, yes, it is important for the provider to provide a space for them to feel comfortable, but I also think the patient has to feel comfortable enough to discuss what’s going on and say, “Hey, this is my situation. This is what I’m going through”. And so, how do you provide that balance? How do you get them to feel comfortable, but then how do you get them to actually communicate? So, it’s just a two-way street.
I think it would have to be obviously community outreach, letting people know wherever they congregate–churches, shopping centers, schools, whatever–starting to increase the awareness of the medication.It’s good knowledge for anybody. And I think that honestly, I know that Texas is very prudish in the way they have information that they give to the kids, especially during their repro health classes in school. But if they would include PrEP and what it’s being used for, I think it would have a better… These kids would have a better understanding.
Bring it up in the pap smears or bring it up in the well women visits.I would say reaching out to more of the OBGYNs.Probably in the primary care or gynecological visits, offering it as just another form of protection against anything in the same way we offer birth control or the same way we encourage condom usage and things like that. Just another low side effects pill that can help prevent things.
…what I like about PrEP is it does decrease the risk of transmission, especially of at-risk populations. I like that we do have now two alternatives, a pill that’s for everyday use and a shot that’s once a week. I’ve seen the studies.I believe it’s highly effective, from what I know, and the dosing, from also what I know, is much easier than when I was in medical school. It used to be very… Actually, there wasn’t even really such thing. We only had PrEP for people who got stuck with a needle, but for the general population who is at higher risk, from what I understand, the dosing is much easier than it used to be. So, it’s more accessible, I guess, is what I’m trying to say, and it’s been proven useful.It’s simple. From what I know, it’s just one pill and it’s once a day. From what I know, like I said, there’s not too many side effects or too much further testing that has to be done afterwards. Yeah, I think those are the best things. It’s easily accessible or available. Most pharmacies carry it within a city and you don’t have to wait too long to get it versus some things have to be flown in and things like that.Just the convenience of the patient being able to have access to it. And then also the funding available for patients. So, if they can’t afford it, then there’s funding available for them to be able to get the medication so that way they don’t have to go without.
3.1.2. Provider Perceptions on PrEP
So, what I like about PrEP is that I feel like it empowers… In this case, it empowers my patients. It empowers women to be able to have something else in their toolkit or on their tool belt to help protect their sexual wellbeing, their overall wellness.In terms of pre-exposure prophylaxis, I think it’s great for the community in terms of helping prevent the spread and helping those who are definitely in need. I think it’s going to be a great… Or it is a great opportunity for those who, especially, are maybe unsure that their partner has this, it can help them along the lines of that as well. Because I know sometimes people are afraid to discuss that specific disease state. And so, that is a great opportunity to help them with that as well, as a preventative measure.
I think it’s definitely a necessary medical treatment. When I have used it in the emergency department setting, usually it’s for someone that unfortunately has been sexually assaulted as part of a forensic nursing sort of thing. And I’ll ask patients if it’s something that they want. And usually I’m doing this in conjunction with a forensic nurse examiner and they will help me figure out the best sort of combination of drugs and everything and then we will either dose it in the ED or give them prescriptions to follow up with…
I think the fact that it’s every three months is definitely manageable…it doesn’t have to be anything that anybody knows about, that they can now have the injection, and it could be just during a regular doctor’s visit and no one would ever know.I think those as a clinician, it’s what you want. You want something to be developed, you want something to be approved, and you want very clear indications of who needs it.
3.1.3. Provider Comfort with Engaging Patients About PrEP
Probably when I go into testing and sexual history, so if they’re having frequent sex or frequent sexual partners or have suspicion that their partner is having sex with other sexual partners, I’ll bring up the different treatments and testing that we can do. And then probably when I mention getting an HIV and AIDS test, I’ll probably mention also if you’re concerned, you can get on PrEP, the once a day pill.I would tell them like, “Hey, I noticed we’ve seen you a couple times in the clinic a lot of times for STD testing. Is it the same partner?” I will ask them is it the same partner? Is your partner stepping out on you or are you just having a lot of partners. She’s like, “Oh, a new boyfriend?” Or they say, “Oh, there’s new partners”. I’m like, okay, well, I’ll first bring up, “Are you using contraception? Are you using condoms?” That kind of stuff.I actually just had one two days ago who came in… Brand new patient came in for vaccines, found out she was sexually active, recently moved to Texas. I can’t remember where she’s from. Turned out she had eight partners in the past. So, we discussed trying to limit partners. Obviously, using condoms to prevent pregnancy and STIs. Drew all the labs like I would for PrEP. Discussed PrEP with PrEP. She didn’t seem interested at the time. So, when she comes back to review all of her blood work, I will again address the conversation of trying to prevent HIV.
I think I’ve only had one female patient that was Black that was interested in PrEP, and she was already taking it, and she was there for a refill. She was taking it because her partner was HIV positive. I won’t say I don’t know, but I don’t recall how the partner became positive. But I know it was a male partner, I remember that much. And she was telling me that, “Yeah, I’ve been on PrEP for a year or two, and I’m just here for the refill”. So, I haven’t had experience of some Black female patient coming in requesting being on PrEP. I have brought it up once or twice before, but they always turned me down because it was more along the lines of like it was basically patients that I suspected had history of multiple STDs, that kind of stuff.
I think it’s also something that I’m a fan of is that as pharmacists, we do play a role in this, by the pharmacology of the drug. And so, what we can do is we can help to decrease the pill burden, and we can help to decrease the amount of pills that patients take. Number one, increase adherence. We play a role in helping to assist with how can we ensure that our patients are getting the best care. And that while they are on these medications, ensuring that these medications are working properly, and that they’re not interacting with other medications that may be on their profile.
3.1.4. Provider Awareness of PrEP Resources
I don’t know. I don’t have any knowledge on that, to be honest.No clue about that, but I do have PrEPs for Descovy come in and they have coupon cards. So, I do have coupon cards for Descovy, kind of like a pay card.I do know there are some payment assistance programs for patients with HIV out there, but I don’t know the specifics about it.
So, on a day-to-day basis, we use databases like Lexicomp, Clinical Pharmacology, UpToDate, PubMed. All of these are databases that have information on medication. And so, as I mentioned throughout our interview, the field is ever evolving, especially with the drugs. And so, we use these databases to ensure, “Hey, I’m telling my patient the right thing. Hey, this is the first time I’m seeing this new combination of drugs, what I need to let them know about. These are the common side effects,” things along those lines.All of the physicians have to do it. You have to continue to learn, so you have to show proof that you’ve continue to learn. We get lots of advertisements, posters, whatever, about different CME activities so you can sign up for one and learn about it.I like to look at scholarly reviewed articles as opposed to just Googling stuff.
So having the presentations, the pharm reps. I’m in the HIV organization. So, I learn information from there as well, and continuing medical education.The reps come in, teach us a little here and there. They’ll bring us packets that kind of show us maybe how to get certain things approved.I think really it would probably be through either continuing education or really department protocols or conferences like our departmental meetings is usually how we would, I think, more uniformly get it amongst a whole group.
3.2. Knowledge
3.2.1. Provider Experience Discussing Sexual Health
I think it’s to, at the very beginning to not be judgmental and respectful, even if it’s not necessarily what you would do, but just everything that we do in medicine is that you’re not going to have the same experience as somebody else to just be like, non-judgmental, non-confrontational and I think be empathetic towards the other person. How would you want to be treated in that circumstance? I think the relationship part is really, really important here because if your patient is not comfortable with you, I don’t think that they will be forthcoming or receptive to your ideas.Always tell them if they have a new sexual partner or if they have a concern, this is always a safe space. Just come back. I use that word a lot in people who are anxious, depressed, like, oh, this is a safe space. Feel free to come back. Let me know. Let me know if there’s any changes. And so those are, I think the way you introduce or the way you have that initial conversation about sex and how you respond will set the precedent for them being able to come back if they have any other concerns.
I just think it’s important that everybody who comes in, regardless of age or gender or whatever, that they realize that their sexual health is important. And I tell them all the time, No one’s going to love you as much as you love yourself. So, if you have sex with somebody and they don’t have a condom, you have to say no. Because they’re just going to do it. So, I’ve tried very hard to get these kids to realize that sex is their choice. Who they have sex with and how they have sex with them is a 100% their choice. And don’t let anybody else make that decision for them.For me, I always ask as we go, as I’m explaining, does that make sense? Do you have any questions? Is there anything that I can explain further for you? And then I’m a visual person, so I pull up visuals.
Again, like I said, I think everybody needs to not just ask, Are you sexually active? Check a box and move on. I think everybody needs to stop and ask those questions. Who are you having sex? How are you having sex? And what are you doing for your own… What are you using? And I think that’s where a lot of people stop. I think they, Are you sexually active? Yep. Okay. And I don’t think they ever delve into what kind of sex and who they’re having sex with. And I think that needs to be standard practice.I don’t do it specifically for one patient population over the other. I try to normalize talking about sex as part of the physical exam, for me, especially when patients come with issues that are related to that. I always ask my patients, “Are you sexually active, yes, no?” And then if they say yes, I always go like, “Okay, male, female partners? One partner? Multiple partners”. I always like to make sure I get a hold of that. Sometimes patients tell me, “Oh, yeah, one, multiple,” or “male, female, both”. Sometimes they don’t feel comfortable discussing it, and that’s okay.
3.2.2. Provider Approach to Patient Engagement
Always try to keep them open. I always ask my high-risk patients, I always try to ask them, like, “Hey, you feeling safe at home? Is anybody pressuring you to do stuff that you don’t feel comfortable doing?” I specifically do that with my younger patients, my 15 to 24, 25 patients. I guess it can happen to anybody at any age, but especially younger patients, I kind of tend to be a little bit more like, “Hey, no one’s pressuring you”. I know if a patient’s younger than 18 and are sexually active, I always like to ask them like, “Hey, how old is your partner? They’re not 30, right? They’re not in their 40s? All right. Cool”. Just making sure there’s nothing crazy going on.For me, I always ask as we go, as I’m explaining, does that make sense? Do you have any questions? Is there anything that I can explain further for you? And then I’m a visual person, so I pull up visuals.
3.2.3. Provider Knowledge of PrEP
I do know there are some payment assistance programs for patients with HIV out there, but I don’t know the specifics about it.Yeah, that’s correct. I don’t have any experience with that.
So, there’s not a whole lot of medicine that we can say, “Hey, this is going to stop this”. PrEP for HIV is one of those. And I think it’s super important that these patients realize that the risk is high, regardless of who you have sex with, whether it’s men, women, both.that they can now have the injection, and it could be just during a regular doctor’s visit and no one would ever know. So, I just love the fact that it is available, that not only the oral, but now the injectable.Today’s the first day I’ve heard about injectable PrEP, so I learned something new today.
I think it’s a good method of preventing HIV in populations that are higher risk. I personally haven’t prescribed it myself, so I’m not really familiar with it, but I’ve definitely heard about it. But I think it is a good thing for prevention.
3.2.4. Provider Approach to Determining PrEP Eligibility
I guess just based on the history. History and physical that we do. And then also the pre-exam questionnaire.I always make sure to ask, “Hey, you’re here for your physical”. If it’s a well woman or a well male exam, “Oh, are you sexually active? Yes, no?” Like I said earlier, I ask a male, female, I’d like to make it not awkward to be like, “Oh, yeah, with who?” So male, female partners, one or multiple partners. Are you using protection, condoms, pills, whatever? That’s kind of where you really suss out the information of who’s going to be at risk, who’s going to be not at risk.
And I talk about PrEP probably once or twice a week with my high risk adolescents who have high number of partners, or men who have sex with men. I bring that conversation up every time I see them.If they are at risk, so if they engage in risky sexual practices, I would consider them at risk.I think anybody who’s at risk. So multiple sexual partners or anyone or patients who are just… No curious but requested and after proper discussion with them, if they are a good candidate, I think they should be able to get it.…every July one, we re-administer that risk assessment. However, I typically ask all of my patients anytime they follow up, I go through our same… Ask if there’s any change in their medical history, allergies, family history. And then I always readdress any smoking, drugs or alcohol. And are you sexually active? So, even though we don’t do a formal evaluation of risk, except once a year, I check risk pretty much at every visit. Those particular, the big ones. Smoking, drugs, alcohol and sexual activity.
… I think everybody needs to not just ask, Are you sexually active? Check a box and move on. I think everybody needs to stop and ask those questions. Who are you having sex? How are you having sex? And what are you doing for your own… What are you using? And I think that’s where a lot of people stop. I think they, Are you sexually active? Yep. Okay. And I don’t think they ever delve into what kind of sex and who they’re having sex with. And I think that needs to be standard practice.I talk about risk all day long. We do what we call a wraps, which is like a 21 question risk assessment that goes all the way from, do you eat fruits and vegetables every day? To self-harm, sexual activity and everything. So, any child that says, yes, that they are sexually active, I discuss type of partners, male, female, both. I discuss what parts of your body do you use to have sex? So, that way, I can gauge what their risk is.Again, I just start out the conversation with… And every time they come, my first questions are after I’ve seen them, have you had any unprotected sex since your last visit? Have you had any new partners since your last visit? And if they tell me no, then I ask them [if they’ve] had any sexual activity at all since your last visit. And it doesn’t matter if they’re here for a hepatitis vaccine, or if they’re here because they have an earache. Any of my sexually active patients, I discuss sexual activity at every visit. So that way, like I said, if I stayed enough times then maybe they’ll believe me that it’s important.
4. Discussion
4.1. Implications for Healthcare Practice
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
# | Self-Awareness | Theme | Codes (n = 1217) | Frequency of Codes |
---|---|---|---|---|
1 | Awareness | Provider awareness of PrEP facilitators | 119 | |
Provider perceptions on how to expand access to PrEP among cisgender Black women | 29 | |||
Provider perceptions on why they like PrEP for patients | 25 | |||
Provider support for offering PrEP is based on their perception of patient risk | 21 | |||
Provider perception on what makes it easier to prescribe PrEP to patients | 10 | |||
Provider perception on facilitators of PrEP use in patients | 7 | |||
Provider perceptions on expanding PrEP access in healthcare systems | 7 | |||
Provider perceptions around patient preferences for injections versus pills | 6 | |||
Provider self-awareness of bias towards patients | 6 | |||
Reason why provider would feel motivated to prescribe PrEP | 6 | |||
Provider reliance on academic resources for PrEP knowledge | 2 | |||
2 | Perception | Provider perceptions on PrEP | 105 | |
Provider perceptions on PrEP | 45 | |||
Provider perceptions on why they like PrEP for patients | 25 | |||
Provider perceptions on how patients would perceive PrEP side effects | 16 | |||
Provider perspective on PrEP within clinical practice | 6 | |||
Reason why provider would feel motivated to prescribe PrEP | 6 | |||
Provider’s perceived knowledge of PrEP side effects | 4 | |||
Provider perceptions that cisgender women are less likely to be referred to PrEP | 3 | |||
3 | Comfort | Provider comfort with engaging patients about PrEP | 104 | |
Provider experience in engaging Black female patients with PrEP | 38 | |||
Provider perceptions on why they like PrEP for patients | 25 | |||
Provider leading PrEP discussions with patients | 6 | |||
Provider self-awareness of bias towards patients | 6 | |||
Provider self-motivation to prescribe more PrEP | 6 | |||
Provider persistence in leading preventative discussions with patients | 4 | |||
Provider willingness to discuss PrEP | 4 | |||
Provider educating patients on PrEP eligibility | 3 | |||
Provider lack of experience engaging Black female patients for PrEP | 3 | |||
Provider comfort in prescribing PrEP | 3 | |||
Provider comfort with engaging patients about PrEP | 2 | |||
Provider discomfort in identifying PrEP-eligible patients | 2 | |||
Provider willingness to engage in PrEP discussion to lower stigma | 2 | |||
4 | Awareness | Provider awareness of PrEP resources | 80 | |
Provider use of resources to gain more knowledge on PrEP | 28 | |||
Provider lack of knowledge on payment assistance programs | 22 | |||
Provider lack of experience with payment assistance programs | 13 | |||
Provider knowledge of local clinics that offer PrEP | 4 | |||
Provider referral of patients to PrEP clinics with lower costs | 4 | |||
Provider use of marketing materials for PrEP | 4 | |||
Provider lack of knowledge on health insurance and PrEP | 4 | |||
Provider knowledge of resources to help patients get access to PrEP | 1 | |||
5 | Desire | Provider desire for direction and more knowledge on PrEP delivery | 76 | |
Provider perceptions on how to expand access to PrEP among cisgender Black women | 29 | |||
Provider use of resources to gain more knowledge on PrEP | 28 | |||
Provider perceptions on expanding PrEP access in healthcare systems | 7 | |||
Provider self-motivation to learn more about PrEP | 4 | |||
Provider willingness to stay informed on PrEP | 3 | |||
Provider desire to learn more about prescribing PrEP | 2 | |||
Provider desire for PrEP guidelines within clinical care | 2 | |||
Provider desire for guidelines and resources on PrEP injectables | 1 | |||
6 | Awareness | Provider awareness of PrEP-related costs | 64 | |
Provider knowledge of payment assistance programs | 15 | |||
Provider awareness of cost as a barrier to PrEP access | 11 | |||
Provider experience with insurance for PrEP | 6 | |||
Provider perception of health insurance and PrEP | 6 | |||
Provider experience with PrEP payments | 5 | |||
Provider limited knowledge on PrEP insurance coverage | 5 | |||
Provider experience with health insurance covering PrEP | 5 | |||
Provider referral of patients to PrEP clinics with lower costs | 4 | |||
Provider lack of knowledge on health insurance and PrEP | 4 | |||
Provider self-awareness of gap in knowledge of PrEP-related costs | 2 | |||
Provider experience with payment assistance programs | 1 | |||
7 | Perception | Provider’s perception of clinical peers engaging patients in sexual health | 64 | |
Provider perceptions on clinical peers’ knowledge of PrEP | 27 | |||
Provider perception on standard practices of healthcare providers for sexual health | 13 | |||
Provider perceptions of gaps in delivery of preventive care amongst clinical peers | 13 | |||
Provider perception of low PrEP knowledge amongst clinical peers | 6 | |||
Knowledge of clinical peers offering PrEP services | 4 | |||
Provider perception of low PrEP knowledge among self and clinical peers | 1 | |||
8 | Awareness | Provider awareness of PrEP barriers | 62 | |
Provider perception on barriers for PrEP use in patients | 17 | |||
Provider perspective on barriers to prescribing PrEP | 14 | |||
Provider perceptions on what may limit willingness to prescribe PrEP | 12 | |||
Provider reasoning for dislike of PrEP for patients | 4 | |||
Provider perceptions that cisgenders are less likely to be referred to PrEP | 3 | |||
Provider self-awareness of gaps in their own preventive care delivery | 3 | |||
Provider perception that men who have sex with men (MSM) are more comfortable referring PrEP | 2 | |||
Provider perception on why access to care varies in other populations | 2 | |||
Provider lack of a PrEP-eligible population due to specialty | 2 | |||
Provider uncertainty of forms of PrEP for cisgender women | 2 | |||
Provider uncertainty of when to offer PrEP | 1 | |||
9 | Awareness | Provider awareness of sexual risk behaviors within patient population | 57 | |
Provider strategy for assessing risk | 38 | |||
Support of PrEP use is based on perception of risk | 9 | |||
Provider discussing PrEP with high-risk populations | 3 | |||
Provider awareness of high-risk behaviors within served population | 2 | |||
Provider support of STD treatment based on perception of risk | 2 | |||
Provider awareness of high-risk behaviors within served population | 2 | |||
Provider awareness of serving high-risk patient population | 1 | |||
10 | Awareness | Provider awareness of unconscious bias | 50 | |
Provider experience with unconscious bias trainings | 20 | |||
Provider self-awareness after unconscious bias training | 14 | |||
Provider self-perception after unconscious bias training | 6 | |||
Provider perceptions that cisgenders are less likely to be referred PrEP | 3 | |||
Provider perception that MSM are more comfortable referring PrEP | 2 | |||
Provider willingness to engage in PrEP discussion to lower stigma | 2 | |||
Provider perception on why access to care varies in other populations | 2 | |||
Provider self-awareness of potential biases | 1 | |||
11 | Awareness | Provider awareness of stigma associated with PrEP | 38 | |
Provider support of offering PrEP is based on their perception of patient risk | 21 | |||
Provider awareness of stigma associated with PrEP | 8 | |||
Provider awareness of stigma behind PrEP | 5 | |||
Provider willingness to engage in PrEP discussion to lower stigma | 2 | |||
Provider perception on why access to care varies in other populations | 2 | |||
12 | Awareness | Provider awareness of requirements of preventive care | 35 | |
Provider broadens preventive considerations when clinical symptoms are absent and sexual risk is known | 17 | |||
Provider awareness on importance of patient follow-ups for preventative measures | 6 | |||
Provider awareness that follow-up care may be needed with PrEP | 5 | |||
Provider experience with patient referrals after prescribing PrEP | 5 | |||
Provider approach to follow-ups | 2 | |||
13 | Awareness | Provider awareness of social determinants of health | 24 | |
Provider knowledge of payment assistance programs | 15 | |||
Provider experience with insurance for PrEP | 6 | |||
Provider awareness of socioeconomic status (SES) as a social determinant of health (SDoH) | 2 | |||
Provider experience with payment assistance programs | 1 | |||
14 | Perception | Provider perception of increasing health literacy in patients | 16 | |
Provider perception on increasing health literacy in patients | 16 | |||
15 | Awareness | Provider awareness of patient comfort level | 15 | |
Provider perceptions around patient preferences for injections versus pills | 6 | |||
Provider perceptions of patient population’s interest in PrEP | 4 | |||
Provider awareness that patient comfort levels vary based on provider gender | 2 | |||
Provider providing a comfortable space for patients | 2 | |||
Provider expecting patient to lead sexual health discussion | 1 | |||
16 | Perception | Provider perception of standard sexual health practices | 14 | |
Provider perception on standard sexual health practices | 14 | |||
17 | Preference | Provider preference for patients to lead sexual health discussions | 6 | |
Provider preference for patient to self-identify need of PrEP | 2 | |||
Support of PrEP is based on patient concern | 2 | |||
Provider preference for patients self-identifying as PrEP-eligible | 1 | |||
Provider expectation for patient to lead sexual health discussion | 1 | |||
18 | Perception | Provider perspective on dispensing PrEP | 4 | |
Pharmacist perspective on process of dispensing PrEP to patients | 4 | |||
19 | Concern | Provider concerns about PrEP side effects | 2 | |
Provider concern for renal disease and kidney function due to PrEP in Black community | 2 |
# | Knowledge | Theme | Codes (n = 1217) | Frequency of Codes |
---|---|---|---|---|
1 | Experience | Provider experience discussing sexual health | 284 | |
Provider approaches to sexual health discussions | 107 | |||
Provider approach in engaging patients in sexual behavior discussions | 85 | |||
Provider experience in engaging Black female patients with PrEP | 38 | |||
Experience discussing sexual health with Black female patients | 16 | |||
Provider leading PrEP discussions with patients | 6 | |||
Provider approach to HIV prevention discussions | 4 | |||
Provider educating patients on PrEP eligibility | 4 | |||
Provider discussing PrEP with high-risk populations | 3 | |||
Provider lacks experience engaging Black female patients for PrEP | 3 | |||
Provider leading sexual health discussion is based on clinical symptoms being present | 3 | |||
Provider comfort with engaging patients about PrEP | 2 | |||
Provider discomfort in identifying PrEP-eligible patients | 2 | |||
Provider experience discussing PrEP | 2 | |||
Provider lack of experience discussing sexual health with Black female patients | 2 | |||
Provider not discussing PrEP with patients | 2 | |||
Provider willingness to engage in PrEP discussion to lower stigma | 2 | |||
Experience discussing sexual health with African American population | 1 | |||
Provider expectation for patient to lead sexual health discussion | 1 | |||
Provider experience discussing sexual health with lesbian patients | 1 | |||
2 | Approach | Provider approach to patient engagement | 240 | |
Provider approaches to sexual health discussions | 192 | |||
Provider self-perception of approach to clinical care | 11 | |||
Provider approach to engaging patients in discussion | 8 | |||
Provider leading PrEP discussions with patients | 6 | |||
Provider approach to HIV prevention discussions | 4 | |||
Provider persistence in leading preventative discussions with patients | 4 | |||
Provider leading sexual health discussion is based on clinical symptoms being present | 3 | |||
Provider self-awareness of gaps in their own preventive care delivery | 3 | |||
Provider providing a comfortable space for patients | 2 | |||
Provider support of STD treatment based on perception of risk | 2 | |||
Provider willingness to engage in PrEP discussion to lower stigma | 2 | |||
Provider approach to follow-ups | 2 | |||
Provider self-awareness of potential biases | 1 | |||
3 | Knowledge | Provider knowledge of PrEP | 158 | |
Provider lack of knowledge on payment assistance programs | 22 | |||
Provider knowledge of PrEP as HIV prevention | 17 | |||
Provider lack of knowledge on PrEP injectable | 16 | |||
Provider knowledge on PrEP oral pills | 15 | |||
Provider knowledge of PrEP delivery routes | 14 | |||
Provider knowledge of PrEP side effects | 12 | |||
Provider knowledge on PrEP-related costs | 12 | |||
Provider perspective on who is eligible for PrEP | 10 | |||
Provider uncertain of PrEP knowledge | 6 | |||
Provider perception of health insurance and PrEP | 6 | |||
Provider lack of knowledge of PrEP side effects | 5 | |||
Provider reasoning for dislike for PrEP for patients | 4 | |||
Provider lack of knowledge on health insurance and PrEP | 4 | |||
Provider knowledge of PrEP | 2 | |||
Provider reliance on academic resources for PrEP knowledge | 2 | |||
Provider knowledge on PrEP oral pills | 2 | |||
Provider knowledge of side effects of oral PrEP | 2 | |||
Provider uncertainty of forms of PrEP for cisgender women | 2 | |||
Provider knowledge of resources to help patients get access to PrEP | 1 | |||
Provider limited knowledge of PrEP delivery routes | 1 | |||
Provider uncertainty of when to offer PrEP | 1 | |||
Provider limited knowledge on PrEP side effects | 1 | |||
Provider perceived knowledge of PrEP side effects | 1 | |||
4 | Approach | Provider approach to determining PrEP eligibility | 141 | |
Provider strategy for assessing risk | 38 | |||
Provider support of offering PrEP is based on their perception of patient risk | 21 | |||
Provider perception on who is PrEP-eligible | 17 | |||
Willingness to offer PrEP to cisgender patients | 16 | |||
Provider approach to determining PrEP eligibility | 13 | |||
Provider self-perception of approach to clinical care | 11 | |||
Support of PrEP use is based on perception of risk | 9 | |||
Provider priorities during clinical discussions | 8 | |||
Provider priorities during clinical visit | 6 | |||
Willingness to prescribe PrEP to Black women | 2 | |||
5 | Experience | Provider experience prescribing PrEP | 56 | |
Provider experience prescribing PrEP | 20 | |||
Provider lack of experience prescribing PrEP | 15 | |||
Provider perception on what makes it easier to prescribe PrEP to patients | 10 | |||
Provider self-motivation to prescribe more PrEP | 6 | |||
Provider comfort in prescribing PrEP | 3 | |||
Provider prescribing PrEP is based on availability | 2 | |||
6 | Knowledge | Provider knowledge gaps with respect to PrEP | 15 | |
Lack of provider knowledge of PrEP-related costs | 8 | |||
Knowledge gap between PrEP and PEP indications | 4 | |||
Provider self-awareness of gap in knowledge with respect to PrEP-related costs | 2 | |||
Provider limited knowledge of PrEP delivery routes | 1 | |||
7 | Training | Provider HIV training focused on treatment | 3 | |
Provider experience with counseling on HIV medication | 2 | |||
Provider training focused more on HIV medication counseling | 1 | |||
8 | Experience | Provider experience with patients taking PrEP | 2 | |
Provider experience with patients using PrEP for prevention | 2 | |||
9 | Education | Provider education through research participation | 1 | |
Provider learning new information from research interview | 1 |
References
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Variables | Subcategories | Respondents (N = 123) | Respondents % | Study Participants (N = 12) | Study Participants % |
---|---|---|---|---|---|
Biological Sex | N = 69 | % | N = 12 | % | |
Female | 45 | 65.22% | 9 | 75.00% | |
Male | 20 | 28.99% | 3 | 25.00% | |
Non-binary/ third gender | 3 | 4.35% | 0 | 0.00% | |
Prefer not to say | 1 | 1.45% | 0 | 0.00% | |
Age | N = 54 | N = 12 | |||
<50 years | 57 | 89.06% | 11 | 91.70% | |
>50 years | 7 | 10.94% | 1 | 8.30% | |
Race | N = 69 | N = 12 | |||
White | 6 | 8.70% | 4 | 33.33% | |
Black or African American | 57 | 82.61% | 5 | 41.70% | |
American Indian or Alaska Native | 2 | 2.90% | 0 | 0.00% | |
Asian | 1 | 1.45% | 1 | 8.30% | |
Other | 3 | 4.35% | 2 | 16.77% | |
Ethnicity | N = 64 | N = 12 | |||
Hispanic/Latino | 15 | 23.44% | 2 | 16.77% | |
Non-Hispanic/Latino | 49 | 76.56% | 10 | 83.33% | |
City of Residence | N = 58 | N = 10 | |||
Houston, TX | 58 | 95.09% | 10 | 83.33% | |
Missing | 3 | 4.92% | 2 | 16.77% | |
English Speaking | N = 70 | N = 12 | |||
Yes | 69 | 98.57% | 12 | 100.00% | |
No | 1 | 1.43% | 0 | 0.00% | |
Healthcare Provider | N = 107 | ||||
Yes | 77 | 71.93% | 12 | 100.00% | |
No | 30 | 28.04% | 0 | 0.00% | |
Type of Healthcare Provider | N = 64 | N = 12 | |||
Nurse Practitioner | 19 | 29.69% | 2 | 16.77% | |
Advanced Practice Provider (APP) | 1 | 1.56% | 0 | 0.00% | |
Physician | 19 | 29.69% | 8 | 66.77% | |
Nurse | 17 | 26.56% | 1 | 8.33% | |
Patient-Facing Pharmacist | 8 | 12.50% | 1 | 8.33% | |
Healthcare Discipline | N = 64 | N = 12 | |||
Reproductive Health | 25 | 39.06% | 1 | 8.33% | |
Family Medicine | 18 | 28.13% | 5 | 41.77% | |
Internal Medicine | 4 | 6.25% | 0 | 0.00% | |
Emergency Medicine | 7 | 10.94% | 4 | 33.33% | |
FQHCs, Local Clinics, or Urgent Care Clinics | 7 | 10.94% | 0 | 0.00% | |
Other | 3 | 4.69% | 2 | 16.77% | |
Length of Career as a Provider | N = 64 | N = 12 | |||
<1 year | 6 | 9.38% | 2 | 16.77% | |
1–5 years | 22 | 34.38% | 4 | 33.33% | |
6-10 years | 26 | 40.63% | 4 | 33.33% | |
11-20 years | 6 | 9.38% | 1 | 8.33% | |
>20 years | 4 | 6.25% | 1 | 8.33% | |
Access to a phone and/or Internet | N = 69 | N = 12 | |||
Yes | 69 | 100.00% | 12 | 100.00% | |
No | 0 | 0.00% | 0 | 0.00% | |
Credentialed to prescribe/refer PrEP | N = 76 | N = 12 | |||
Yes | 69 | 90.79% | 12 | 100.00% | |
No | 7 | 9.21% | 0 | 0.00% | |
Willing to participate | N = 63 | N = 12 | |||
Yes | 62 | 98.41% | 12 | 100.00% | |
No | 1 | 1.59% | 0 | 0.00% |
# | Self-Awareness | Theme | Codes | Frequency of Codes |
---|---|---|---|---|
1 | Awareness | Provider awareness of PrEP facilitators | ||
Provider perceptions on how to expand access to PrEP in cisgender Black women | 29 | |||
Provider’s perceptions on why they like PrEP for patients | 25 | |||
2 | Perception | Provider perceptions on PrEP | ||
Provider perceptions on PrEP | 45 | |||
Provider’s perceptions on why they like PrEP for patients | 25 | |||
3 | Comfort | Provider comfort with engaging patients about PrEP | ||
Provider experience in engaging Black female patients with PrEP | 38 | |||
Provider’s perceptions on why they like PrEP for patients | 25 |
# | Knowledge | Theme | Codes | Frequency of Codes |
---|---|---|---|---|
1 | Experience | Provider’s experience discussing sexual health | ||
Provider approaches to sexual health discussions | 107 | |||
Provider approach in engaging patients in sexual behavior discussions | 85 | |||
2 | Approach | Provider approach to patient engagement | ||
Provider approaches to sexual health discussions | 192 | |||
Provider’s self-perception of approach to clinical care | 11 | |||
3 | Knowledge | Provider knowledge of PrEP | ||
Provider lack of knowledge on payment assistance programs | 22 | |||
Provider knowledge of PrEP as HIV prevention | 17 | |||
Provider lack of knowledge on PrEP injectable | 16 | |||
4 | Approach | Provider approach to determining PrEP eligibility | ||
Provider’s strategy for assessing risk | 38 | |||
Provider support for offering PrEP is based on their perception of patient risk | 21 |
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Hill, M.J.; Sophus, A.I.; Sapp, S.; Campbell, J.; Santa Maria, D.; Stockman, J.K. Examining Perceptions Among Healthcare Providers on Their Awareness of and Experience with Prescribing and/or Referring Pre-Exposure Prophylaxis to Eligible Cisgender Black Female Patients: A Qualitative Inquiry. Int. J. Environ. Res. Public Health 2025, 22, 450. https://doi.org/10.3390/ijerph22030450
Hill MJ, Sophus AI, Sapp S, Campbell J, Santa Maria D, Stockman JK. Examining Perceptions Among Healthcare Providers on Their Awareness of and Experience with Prescribing and/or Referring Pre-Exposure Prophylaxis to Eligible Cisgender Black Female Patients: A Qualitative Inquiry. International Journal of Environmental Research and Public Health. 2025; 22(3):450. https://doi.org/10.3390/ijerph22030450
Chicago/Turabian StyleHill, Mandy J., Amber I. Sophus, Sarah Sapp, Jeffrey Campbell, Diane Santa Maria, and Jamila K. Stockman. 2025. "Examining Perceptions Among Healthcare Providers on Their Awareness of and Experience with Prescribing and/or Referring Pre-Exposure Prophylaxis to Eligible Cisgender Black Female Patients: A Qualitative Inquiry" International Journal of Environmental Research and Public Health 22, no. 3: 450. https://doi.org/10.3390/ijerph22030450
APA StyleHill, M. J., Sophus, A. I., Sapp, S., Campbell, J., Santa Maria, D., & Stockman, J. K. (2025). Examining Perceptions Among Healthcare Providers on Their Awareness of and Experience with Prescribing and/or Referring Pre-Exposure Prophylaxis to Eligible Cisgender Black Female Patients: A Qualitative Inquiry. International Journal of Environmental Research and Public Health, 22(3), 450. https://doi.org/10.3390/ijerph22030450