Identification of Provider Barriers and Facilitators to Integration of Pre-Exposure Prophylaxis into Postpartum Care

Abstract

The postpartum period presents an opportunity to provide pre-exposure prophylaxis (PrEP) to cisgender women who may benefit. As patients rely on providers to provide PrEP education and frame relevance, barriers and facilitators to providers’ initiating sexual health and HIV prevention discussions as a part of postpartum care must be identified to support implementation. Semi-structured interviews with 33 postpartum providers (10 residents, 6 advanced practice providers, 6 attendings, and 11 registered nurses) were conducted utilizing social cognitive theory as a framework. Providers expected that their postpartum patients would find HIV prevention discussions uncomfortable, not personally relevant, and/or stigmatizing. Providers identified normalization of PrEP discussions, universalization of PrEP discussions and tailoring conversations to meet their patients’ needs as strategies to support comfort and confidence in discussing PrEP with their patients. Providers who believed that obstetrical care extended beyond an exclusive focus on pregnancy identified the postpartum context as an opportunity to provide PrEP education and other sexual health services. Providers identified environmental barriers, including frequent interruptions, language barriers, and lack of time for discussions. Nurses demonstrated receptivity to discussing PrEP, suggesting task shifting as a potential implementation strategy for integration of PrEP into postpartum care. Findings indicate that to support integration of PrEP into postpartum care, providers must be (1) educated on patient preferences surrounding sexual health discussions to align their expectations, (2) empowered with communication strategies that support normalization and tailoring of universally delivered PrEP education, and (3) supported in providing postpartum care that is comprehensive and includes education about HIV prevention.