In recent years, a number of pre-exposure prophylaxis (PrEP) medications and dosing strategies have become available to patients to help prevent human immunodeficiency virus (HIV) infection. The primary objective of this research was to assess current PrEP awareness and prescribing practices of family medicine providers at the Hinesburg Family Medicine practice in Hinesburg, VT.https://scholarworks.uvm.edu/fmclerk/1769/thumbnail.jp

Flynn, Christopher

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University of Vermont UVM ScholarWorks Family Medicine Clerkship Student Projects Family Medicine Community 2021 How PrEPped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV Prevention Christopher Flynn Larner College of Medicine at the University of Vermont Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk  Part of the Immune System Diseases Commons, Medical Education Commons, and the Primary Care Commons Recommended Citation Flynn, Christopher, "How PrEPped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV Prevention" (2021). Family Medicine Clerkship Student Projects. 686. https://scholarworks.uvm.edu/fmclerk/686 This Book is brought to you for free and open access by the Family Medicine Community at UVM ScholarWorks. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of UVM ScholarWorks. For more information, please contact donna.omalley@uvm.edu. How PrEPped Are Our Providers?Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV PreventionChristopher FlynnMS3 – Larner College of Medicine at the University of VermontFamily Medicine Clerkship – Hinesburg Family PracticeAHEC Scholars Core Topic: Current and Emerging Health IssuesPre-exposure Prophylaxis (PrEP): Medications, Use Metrics, and Associated ProblemsProblem: Constant release of new data/guidelines can be difficult to keep track of “best” available PrEP medications and dosing strategies◦ Approved PrEP medications: Truvada (tenofovir disoproxil fumarate-emtricitabine; 2012 FDA approval) & Descovy (tenofovir alafenamide fumarate-emtricitabine; 2019 FDA approval)◦ Dosing strategies: once daily pill vs. “on demand”, “event-driven”      (2-1-1) ◦ Further compounded by prior research indicating providers’ lack of training surrounding PrEP prescribing practicesEstimated PrEP users (as of 2018): 200,000-205,000 (US), 187 (VT)TONY WEBSTER. (PHOTOGRAPHER). (2020). GILEAD SCIENCES DESCOVY FOR HIV PREP [PHOTOGRAPH]. RETRIEVED 05/05/2021, FROM HTTPS://WWW.FLICKR.COM/PHOTOS/DIVERSEY/49765063118TONY WEBSTER. (PHOTOGRAPHER). (2019). TRUVADA (EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE) TABLETS [PHOTOGRAPH]. RETRIEVED 05/05/2021, FROM HTTPS://WWW.FLICKR.COM/PHOTOS/DIVERSEY/48609563248HIV Statistics & Associated CostsVT HIV Statistics (as of 2018)Number of total diagnosed cases 711 Newly diagnosed cases (2018) 18MSM transmission for newly diagnosed cases (2018)43%Number of PrEP users 187 (94.7% male)(Vermont) (Vermont)Despite rising trend in number of PrEP users, number of cases per year remains relatively stableMajority of VT’s cases are in Chittenden countyEstimated lifetime cost for early HIV diagnosis is >$400,000◦ Prevention is the focus!◦ $907,375 to VT for HIV federally funded grants/programs (FY2018)Perspective of Members of the CommunityOne of the main issues we face is not asking the right screening questions of our patients—for example, a gay man versus a heterosexual man—to truly understand their needs. This issue is further heightened by our patient population. With a seemingly decreased need for PrEP among our patients, this is not a situation we routinely face, thus I would imagine there would be greater unfamiliarity. Conversely, I would imagine a greater need for PrEP in regions of the state with a younger patient demographic.-Family Medicine ProviderIn the last year, as in-person appointments became restricted, HIV testing access was consolidated to a few core medical providers, which resulted in fewer tests and fewer PrEP referrals. I imagine, also, fewer people continued their prescriptions for PrEP, along with those more limited new prescriptions. We anticipate at Vermont CARES we should be able to resume in-person rapid-result HIV testing this summer, and consequently we know guided referrals to PrEP will increase. One dilemma we face now is that the landscape for referrals and prior routines has changed dramatically for all providers, so we will be re-learning protocols for PrEP access in real-time along with those we serve. -Peter Jacobsen, Executive Director of Vermont CARESAnne Karakash. (Photographer). (2019). Untitled [Doctor’s Office, Photograph]. Retrieved 05/05/2021, from https://pixabay.com/photos/doctors-office-doctor-office-1944117/Intervention & MethodologyReviewed prior Family Medicine Clerkship projects focusing on PrEP as a novel preventative medicine to compare with multiple options currently available to patientsProviders (MDs/NPs) at the Hinesburg Family Medicine practice were asked to complete anonymous survey assessing awareness and prescribing practices of PrEPReview of survey data highlighted varying levels of knowledge, as well as comfortability and confidence discussing PrEP with patientsGoal: Equip providers with updated guidelines to increase knowledge and confidence when discussing current options for PrEP with patientsGive information sheet to all providers in the practice regarding current clinical guidelines for PrEPSurvey Data ResultsAll respondents reported knowledge of PrEP and correctly identified its purpose40% reported reading current PrEP clinical practice guidelines (CDC)100% of respondents aware of Truvada use as PrEP vs. 20% aware of Descovy use as PrEPProvider willingness/readiness to discuss and prescribe PrEP reported as very willing (60%) or somewhat willing (40%)Providers’ familiarity with dosing regimens:• Greater familiarity with once daily dosing (strongly agree + somewhat agree, 80%)• Less familiar with “on-demand” dosing (somewhat agree + neither agree nor disagree, 100%)Top provider-reported barriers for prescribing PrEP:• Cost-related concerns (80%)• Provider perception of patient risk status (60%)• Lack of knowledge, training or experience with PrEP (40%)• Time constraint (40%)Survey Data Results (cont.)Evaluation of Intervention“Use it or lose it” phenomenon: relatively low number of PrEP prescriptions in the state potentially due to low need◦ Less frequent discussion point between providers and patients, thus providers potentially less likely to keep current with updated guidelines◦ Influence of provider’s perspective of perceived need for individual patient or community at largeSurvey data along with community member interviews highlight implications of providers’ own biases impacting patient encountersDespite small sample size, fair amount of variability emphasizes need for continued education efforts, especially for minority patient populationsResults of survey are largely qualitative◦ Potential follow-up 1: Assess differences in PrEP prescribing/counseling practices among providers who reviewed PrEP info sheet vs. another family medicine practice with similar patient demographics◦ Potential follow-up 2: Survey providers in the practice who reviewed PrEP info sheet and assess changes in comfortability and confidence in PrEP counseling/prescribing practicesReferencesAIDSVu – Local Data: Vermont, 2018. https://aidsvu.org/local-data/united-states/northeast/vermont/CDC: HIV—Prevention (PrEP), 2020. https://www.cdc.gov/hiv/basics/prep.html CDC: HIV surveillance report, 2018. https://www.cdc.gov/hiv/pdf/library/infographics/cdc-hiv-surveillance-vol-31-infographic.pdfCDC: Preexposure prophylaxis for the prevention of HIV infection in the United State – 2017 update: a clinical practice guideline, 2017. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdfCDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Selected National HIV Prevention and Care Outcomes, 2018. https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-prevention-and-care-outcomes-2018.pdfGilead Sciences: Full prescribing information, Descovy, 2021. https://www.gilead.com/-/media/files/pdfs/medicines/hiv/descovy/descovy_pi.pdfKrakower, D.S., et al. Tenofovir Alafenamide for HIV Preexposure Prophylaxis: What Can We DISCOVER About Its True Value? Annals of Internal Medicine. 2020; 172(4):281-282. doi: 10.7326/M19-3337.Molina, J.M., et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. New England Journal of Medicine. 2015; 373(23), 2237-2246. NAM AIDS Map: WHO endorses event-driven PrEP for gay men, 2019. https://www.aidsmap.com/news/jul-2019/who-endorses-event-driven-prep-gay-menOhkura, M. Facilitating HIV Pre-Exposure Prophylaxis (PrEP) Familiarity Among Vermont Primary Care Providers, 2016. Family Medicine Clerkship Student Projects. 193.San Francisco AIDS Foundation: Q&A: PrEP 2-1-1 for anal sex, 2019. sfaf.org/resource-library/qa-prep-2-1-1-for-anal-sex/San Francisco AIDS Foundation: Side-by-side comparison: Truvada and Descovy for PrEP, 2019. https://www.sfaf.org/resource-library/side-by-side-comparison-truvada-and-descovy-for-prep/U.S. Preventative Services Task Force: Prevention of Human Immunodeficiency Virus (HIV) Infection: Preexposure Prophylaxis, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxisVermont Department of Health: HIV surveillance, 2019. https://www.cdc.gov/hiv/basics/prep.htmlWorld Health Organization, 2019. What’s the 2-1-1-? Event driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: Update to WHO’s recommendation on oral PrEP. https://apps.who.int/iris/bitstream/handle/10665/325955/WHO-CDS-HIV-19.8-eng.pdf?ua=1

How PrEPped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV Prevention

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How PrEPped Are Our Providers?: Assessing Vermont Primary Care Providers’ Knowledge and Awareness of Pre-Exposure Prophylaxis (PrEP) Options for HIV Prevention

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