Cisgender women account for approximately 20% of new HIV diagnoses in the U.S., yet of those indicated for pre-exposure prophylaxis (PrEP) uptake is only 10%. Cisgender women are amenable to PrEP; however, clinicians encounter individual and interpersonal barriers to prescriptions. This research examines clinicians' decision-making processes regarding PrEP provision for cisgender women. Semi-structured individual interviews were conducted with clinicians working with cisgender women in the U.S. to explore their decision-making processes for PrEP prescription and were presented with a vignette of a hypothetical patient. Clinicians were asked how they would assess their eligibility for PrEP and their clinical recommendations. Eighteen clinicians were interviewed. The majority reported at least some familiarity with PrEP. The majority were practicing clinicians trained as OB/GYNs, followed by Primary Care/Family/Internal Medicine. Clinicians frequently report their PrEP recommendations rely on the patient's overall risk and ability to use condoms. Clinicians' decision-making processes often follow a linear pathway through (1) the assessment of HIV risk, (2) STI testing, (3) condom counseling, and (4) PrEP counseling and provision. Despite medical guidelines recommending PrEP to all sexually active patients, clinicians rely on condoms as the primary prevention method and continue to assess the utility of PrEP through a risk-focused lens.
Flores et al. (Thu,) studied this question.