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      Healthcare providers’ knowledge, readiness, prescribing behaviors, and perceived barriers regarding routine HIV testing and pre-exposure prophylaxis in DeLand, Florida

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          Abstract

          Objectives:

          Florida ranks highest in the United States among newly diagnosed HIV infections. This ranking reflects the need for investigation of healthcare providers’ knowledge, readiness, prescribing behaviors, and perceived barriers to routine HIV testing and pre-exposure prophylaxis.

          Methods:

          We adapted national questionnaires with questions co-developed with Florida Department of Health to form a 25-item instrument. Questionnaires were distributed to the population of eligible healthcare providers in DeLand, Florida.

          Results:

          Results from an approximate 20% response rate that encompasses 12 providers demonstrate baseline findings to inform future studies. For example, 75% of respondents were aware of FL Administrative Code 64D-3.042 that pregnant women should receive HIV testing during first and third trimesters. However, 50% of respondents rarely or never offer tests to pregnant women according to practice guidelines. About 75% of respondents strongly agree or agree with willingness to prescribe pre-exposure prophylaxis to high-risk patients, yet 8.3% always or very often prescribe pre-exposure prophylaxis.

          Conclusions:

          Results convey the importance of and need for greater collaboration between providers and the Florida Department of Health to enhance providers’ knowledge, readiness, and, ultimately, behaviors regarding routine HIV testing and pre-exposure prophylaxis prescription.

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          Most cited references39

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          Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.

          Bernard M. Branson, H. Hunter Handsfield, Margaret Lampe … (2006)
          These recommendations for human immunodeficiency virus (HIV) testing are intended for all health-care providers in the public and private sectors, including those working in hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health-care facilities, and primary care settings. The recommendations address HIV testing in health-care settings only. They do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans). The objectives of these recommendations are to increase HIV screening of patients, including pregnant women, in health-care settings; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce perinatal transmission of HIV in the United States. These revised recommendations update previous recommendations for HIV testing in health-care settings and for screening of pregnant women (CDC. Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings. MMWR 1993;42[No. RR-2]:1-10; CDC. Revised guidelines for HIV counseling, testing, and referral. MMWR 2001;50[No. RR-19]:1-62; and CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50[No. RR-19]:63-85). Major revisions from previously published guidelines are as follows: For patients in all health-care settings HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Persons at high risk for HIV infection should be screened for HIV at least annually. Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings. For pregnant women HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women. HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening). Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing. Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.
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            HIV providers' perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study.

            Douglas Krakower, Norma Ware, Jennifer Mitty … (2014)
            Oral pre-exposure prophylaxis (PrEP) can reduce HIV incidence among at-risk persons. However, for PrEP to have an impact in decreasing HIV incidence, clinicians will need to be willing to prescribe PrEP. HIV specialists are experienced in using antiretroviral medications, and could readily provide PrEP, but may not care for HIV-uninfected patients. Six focus groups with 39 Boston area HIV care providers were conducted (May-June 2012) to assess perceived barriers and facilitators to prescribing PrEP. Participants articulated logistical and theoretical barriers, such as concerns about PrEP effectiveness in real-world settings, potential unintended consequences (e.g., risk disinhibition and medication toxicity), and a belief that PrEP provision would be more feasible in primary care clinics. They identified several facilitators to prescribing PrEP, including patient motivation and normative guidelines. Overall, participants reported limited prescribing intentions. Without interventions to address HIV providers' concerns, implementation of PrEP in HIV clinics may be limited.
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              Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement.

              V Moyer (2013)
              Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for HIV. The USPSTF reviewed new evidence on the effectiveness of treatments in HIV-infected persons with CD4 counts greater than 0.200 × 109 cells/L; effects of screening, counseling, and antiretroviral therapy (ART) use on risky behaviors and HIV transmission risk; and long-term cardiovascular harms of ART. These recommendations apply to adolescents, adults, and pregnant women. The USPSTF recommends that clinicians screen adolescents and adults aged 15 to 65 years for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened. (Grade A recommendation)The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. (Grade A recommendation).
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                Author and article information

                Journal
                Journal ID (nlm-ta): SAGE Open Med
                Journal ID (iso-abbrev): SAGE Open Med
                Journal ID (publisher-id): SMO
                Journal ID (hwp): spsmo
                Title: SAGE Open Medicine
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Electronic): 2050-3121
                Publication date (Electronic): 11 March 2019
                Publication date Collection: 2019
                Volume: 7
                Electronic Location Identifier: 2050312119836030
                Affiliations
                [1 ]Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
                [2 ]School of Public Health, Imperial College London, London, UK
                [3 ]Public Health Program, Stetson University, DeLand, FL, USA
                [4 ]Infectious Disease Management, Intervention, and Community Practice, University of Pittsburgh, Pittsburgh, PA, USA
                [5 ]Disease Control and Health Protection, Florida Department of Health in Volusia County, Daytona Beach, FL, USA
                [6 ]Office of Planning and Performance Management, Florida Department of Health in Volusia County, Daytona Beach, FL, USA
                Author notes
                [*]Laura H Gunn, Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA. Email: lgunn@ 123456uncc.edu
                Author information
                https://orcid.org/0000-0003-3962-4526
                Article
                Publisher ID: 10.1177_2050312119836030
                DOI: 10.1177/2050312119836030
                PMC ID: 6413419
                PubMed ID: 30886716
                SO-VID: d6c5f6a2-ad22-472b-91d5-15dd5729ce6f
                Copyright © © The Author(s) 2019
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 18 July 2018
                Date accepted : 4 January 2019
                Categories
                Subject: Original Article
                Custom metadata
                cover-date January-December 2019

                Keywords: routine hiv testing,prep,provider knowledge,prescribing behaviors,provider-perceived barriers
                Data availability:
                Keywords: routine hiv testing, prep, provider knowledge, prescribing behaviors, provider-perceived barriers

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