Understanding the PrEP Care Continuum for Adults: Health Care Providers' Perspectives on Barriers, Facilitators, and Missed Opportunities.

Abstract

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.