Health Care Providers’ Reported Barriers to Pre-Exposure Prophylaxis Initiation Among Cisgender Women

Abstract

Previous research has demonstrated that sexual and reproductive health care providers never or rarely prescribe pre-exposure prophylaxis (PrEP) to cisgender women, despite their perception that HIV burden is high in this population. The present research was therefore designed to explore: (1) providers’ PrEP knowledge and relevant experiences, (2) providers’ willingness to prescribe PrEP to cisgender women, and (3) providers’ perceived barriers to PrEP uptake among cisgender women at the systems/community level, clinician level, and patient level. We conducted semistructured individual interviews with 18 health care providers currently working in a clinical capacity with cisgender women, including Obstetrics/Gynecology (OB/GYN) (n = 10), Primary Care (n = 4), Infectious Disease (n = 2), and Other Specialty (n = 2) providers. Participants practiced in 12 states across the Northeast (n = 10), West Coast (n = 4), South (n = 3), and Midwest (n = 1) regions of the United States. Interviews were coded using inductive/deductive hybrid thematic analysis. Of the 18 health care providers interviewed, nearly all (n = 17) expressed willingness to prescribe PrEP. However, among those theoretically willing to prescribe PrEP, fewer than half (n = 8) had ever prescribed it. When asked open-ended questions about their attitudes and experiences, all providers identified barriers to prescribing PrEP to cisgender women. These barriers fell into four categories: (1) knowledge, messaging, and (mis)information; (2) stigma and/or fear of stigma; (3) characteristics of the medication itself; and (4) accessibility of health care services. We discuss the implications for developing interventions to address the identified implementation gap and increase PrEP access and uptake among cisgender women.