PrEP initiation in the primary care setting: An integrative review
Tia L. Harper, BSN, RN, DNP Candidate - Nell Hodgson Woodruff School of Nursing, Emory University- email@example.com and Sharon Leslie, MSLS, AHIP - Woodruff Health Sciences Center Library, Emory University
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Guideline-driven initiation of pre-exposure prophylaxis (PrEP) is a safe and effective strategy for reducing the incidence of human immunodeficiency virus (HIV). Yet, PrEP initiation is generally inadequate allowing for a persistently high HIV prevalence in the United States. The aims of this integrative review were to identify and examine barriers contributing to suboptimal PrEP prescribing by primary care providers (PCPs), establish which practice-based intervention(s) are most effective in improving PCP PrEP prescribing practices, and guide implementation of such intervention(s) via hypothetical case study provision. Review objectives were intended to result in answering how implementing practice-based interventions affects PCP PrEP prescribing compared to no intervention implementation. For this integrative literature review, six bibliographic databases were searched (e.g., CINAHL, PsychINFO, and MEDLINE). Data extraction and analysis using appraisal tools were completed for included studies. Primary themes emerged regarding factors contributing to inadequate PrEP prescribing in primary care: Insufficient PCP PrEP knowledge, lacking HIV risk and/or PrEP eligibility screening, and challenges regarding provider-patient discussions related to PrEP and associated aspects. However, researchers of several studies examined the effect of practice-based interventions intended to improve PrEP-related practices in primary care with subsequent positive results. Review findings elucidate the need for enhanced PCP knowledge regarding PrEP to lessen the PrEP utilization gap and reveal fulfillment of such need is feasible. Practice-level education-based interventions aimed at increasing knowledge regarding PrEP and related factors (e.g., initiation guidelines, sexual history taking, and LGBTQIA+ cultural awareness) are recommended to improve and optimize PCP PrEP prescribing practices. To facilitate implementation of recommended interventions, an evidence-based hypothetical case study was developed to serve as a framework.
|Type||DNP Capstone Project|
|Review Type||None: Degree-based Submission|
|Evidence Level||Literature Review|
|Research Approach||Translational Research/Evidence-based Practice|
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