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HCP PrEP Knowledge
PrEP Persistence Depends on Healthcare Professional Knowledge: A Patient’s Perspective

Released: November 16, 2023

Martin Rios
Martin Rios,
Activity Information

Activity

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Key Takeaways
  • Pre-exposure prophylaxis (PrEP) persistence requires a person to have ongoing access to PrEP care.
  • PrEP persistence relies on healthcare professionals being knowledgeable about PrEP.
  • A healthcare professional’s ability to confidently discuss PrEP options and prescribe different PrEP modalities may help people to persist on PrEP.

I began taking HIV pre-exposure prophyalxis (PrEP) soon after finishing college around the age of 22. In the 3 years since I began taking PrEP, my providers have been either the biggest supporters of or barriers to me receiving the HIV prevention care I am asking for.

The Impact of Knowledgeable Providers of PrEP
I have had 5 different healthcare professionals (HCPs) provide PrEP since starting it. Of those 5 HCPs, 3 were well informed about PrEP and supportive of me taking it. These 3 HCPs are all located inside the same medical office that primarily serves minoritized populations and have demonstrated a real passion for providing care for everyone they serve. When I began seeing them, I had been taking a daily PrEP pill and shared my concerns about it. Sometimes I missed pills or would take 2 each day instead of 1 because I would forget if I had already taken one. My HCP listened to me and immediately recommended that I consider an injectable form of PrEP. I was aware of injectable PrEP but was unsure about using it and honestly scared to inquire about it. It was extremely reassuring to be offered this option without being the one to ask. They discussed all the differences between oral and injectable PrEP with me, and I made the decision to switch to injectable PrEP at that time. I now have an appointment every 2 months to get my injection and do not have to worry about missing a pill or taking double and then running out before my next prescription refill is due.

HCPs as a Barrier to PrEP Access and Persistence
Unfortunately, though, I have not always had the same positive experience with all HCPs. The first HCP I had after college almost denied me PrEP altogether. Entering the office for my first visit, they asked me what concerns I had and asked questions about how I lived my life. At the time, I had been having more anonymous relations and constantly had fears and concerns about acquiring a sexually transmitted infection. When disclosing this, my HCP recommended that I try to remain abstinent. I knew of PrEP at this point and asked about it because abstinence was not something I was interested in. My HCP told me that they did not write prescriptions for PrEP because they were unsure of its use and benefit. I asked what PrEP trials and papers they had reviewed, and they spoke to me in a condescending tone and said, “You wouldn’t understand them.” After some discussion back and forth, they only wrote me a PrEP prescription after I told them to document “Denied PrEP after patient asked for it” in my medical record.

I switched to another HCP within my network soon after. My next HCP was older and did not know what PrEP was. I had to inform them of what it was, and they asked for a few minutes to do some research. I appreciated their willingness to learn in that moment but was disappointed that they were unaware of such an important HIV prevention tool. They did prescribe PrEP for me for the next 6 months until my insurance changed, and that is why I switched HCPs and ended up at my current medical office.

The Importance of HCPs Keeping Abreast of PrEP Advances
The medical field is not stagnant, even if some of those who are in the profession are. Practices are ever-changing and evolving but HCPs may not keep up with the constant changes and therapeutic innovations. My access to care depends on who is willing to continue to learn and adapt and who is not. Being denied care due to an HCP’s lack of knowledge of and subsequent unwillingness to prescribe PrEP is disheartening, especially when that care has such an important impact on my everyday life—providing me with peace of mind. I am preparing to move soon and can only hope my next HCP will be educated about and facilitate my access to PrEP care without me having to fight for it. 

Your Thoughts?
How do you approach discussions with your patients when they ask you about PrEP? Join the discussion by posting a comment.