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Clinical Science

Category: PrEP - HIV

(P296) Current HIV Preexposure Prophylaxis practices in Florida: focus groups with the Clinicians

Wednesday, July 26, 2023
16:00 – 18:00 CST
Background

Florida leads the U.S. in the number of new HIV cases, despite the availability of pre-exposure prophylaxis (PrEP), an effective prevention strategy for reducing HIV acquisition. To date, PrEP remains underutilized; thus, it is critical to understand clinicians’ current PrEP practices to find the gap and promote this evidence-based intervention. In this study, we explored how clinicians currently identify PrEP candidates and use electronic health records (EHRs) for HIV risk assessment and what the challenges are in determining a PrEP candidate.

Methods

A qualitative study was conducted using remote focus groups with 15 clinicians (11 physicians and 4 nurses) who have experience with prescribing PrEP in Florida between October 22 to November 22, 2021. Focus group data were analyzed using thematic content analysis.

Results

The major themes identified included the HIV risk assessment process, following CDC’s PrEP practice guideline, looking for HIV risk indicators from EHRs, challenges in manually retrieving information from EHRs, and potential barriers to identifying a PrEP candidate. The majority of clinicians (n=8) used CDC clinical practice guidelines to assess patients’ HIV risks and identified sexual histories as the major indicator of PrEP eligibility. Moreover, six clinicians reported prescribing PrEP to patients who asked for it. Likewise, most clinicians (n=9) felt EHRs are somewhat helpful in determining patients' HIV risk. Apart from sexual behavior (n=7) and sexually transmitted infections (n=8), clinicians identified substance use and needle sharing as potential risk factors (n=6); thus, they look for this information in the EHRs. Clinicians also discussed challenges retrieving information from huge EHRs manually, the difficulty of pooling outside EHRs, and patient privacy and stigma. Major barriers to PrEP practices include loss to follow-up, the stigma around sexuality, lack of PrEP knowledge among patients and providers, funding sources, and physician willingness.

Conclusion

Study findings suggest the gaps in current PrEP practices and potential usefulness in mining risk factors from existing EHRs, which are essential sectors to improve PrEP practices in Florida. An effective sexual history taking tool to identify HIV risk factors and an EHR-based risk prediction model can facilitate identifying PrEP candidates.