Australian interdisciplinary healthcare providers.

BACKGROUND The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers' (HCP) knowledge and preparedness to prescribe PrEP remains limited. METHODS Semistructured interviews, conducted before PBS listing (October 2016-April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. RESULTS Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia's universal healthcare insurance system). CONCLUSIONS Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.

[1]  C. Newman,et al.  Troubling the non-specialist prescription of HIV pre-exposure prophylaxis (PrEP): the views of Australian HIV experts , 2020, Health sociology review : the journal of the Health Section of the Australian Sociological Association.

[2]  William Arbuthnot Sir Lane,et al.  HIV pre-exposure prophylaxis: Knowledge and attitudes among general practitioners. , 2019, Australian journal of general practice.

[3]  J. Molina,et al.  Give PrEP a chance: moving on from the “risk compensation” concept , 2019, Journal of the International AIDS Society.

[4]  M. Hellard,et al.  Assessment of service refinement and its impact on repeat HIV testing by client's access to Australia's universal healthcare system: a retrospective cohort study , 2019, Journal of the International AIDS Society.

[5]  A. Hope,et al.  “No‐one’s driving this bus” – qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men , 2018, Australian and New Zealand journal of public health.

[6]  C. Newman,et al.  Promoting ‘Equitable Access’ to PrEP in Australia: Taking Account of Stakeholder Perspectives , 2018, AIDS and Behavior.

[7]  B. Vuylsteke,et al.  Choosing Between Daily and Event-Driven Pre-exposure Prophylaxis: Results of a Belgian PrEP Demonstration Project , 2018, Journal of acquired immune deficiency syndromes.

[8]  A. McNulty,et al.  Nurse-led pre-exposure prophylaxis: a non-traditional model to provide HIV prevention in a resource-constrained, pragmatic clinical trial. , 2018, Sexual health.

[9]  J. D. de Wit,et al.  Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013-17. , 2018, The lancet. HIV.

[10]  M. Boyd,et al.  Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. Update April 2018 , 2018, Journal of virus eradication.

[11]  S. Golub,et al.  PrEP Stigma: Implicit and Explicit Drivers of Disparity , 2018, Current HIV/AIDS Reports.

[12]  A. Hogewoning,et al.  The Acceptability of Pre-Exposure Prophylaxis: Beliefs of Health-Care Professionals Working in Sexually Transmitted Infections Clinics and HIV Treatment Centers , 2018, Front. Public Health.

[13]  P. Yates,et al.  Nurse-led services in Queensland: A scoping study , 2017, Collegian.

[14]  C. O'Connor,et al.  Preexposure Prophylaxis of HIV Infection: the Role of Clinical Practices in Ending the HIV Epidemic , 2017, Current HIV/AIDS Reports.

[15]  M. Wainberg,et al.  Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. , 2017, The lancet. HIV.

[16]  J. Fuchs,et al.  Brief Report: Informing Strategies to Build PrEP Capacity Among San Francisco Bay Area Clinicians , 2017, Journal of acquired immune deficiency syndromes.

[17]  J. Kelly,et al.  PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists , 2017, AIDS and Behavior.

[18]  V. Patel,et al.  Primary Care Physicians’ Willingness to Prescribe HIV Pre-exposure Prophylaxis for People who Inject Drugs , 2017, AIDS and Behavior.

[19]  R. Grant,et al.  Values and Preferences on the Use of Oral Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Multiple Populations: A Systematic Review of the Literature , 2016, AIDS and Behavior.

[20]  G. Zimet,et al.  Adolescent Human Immunodeficiency Virus Care Providers' Attitudes Toward the Use of Oral Pre-Exposure Prophylaxis in Youth. , 2016, AIDS patient care and STDs.

[21]  J. Dovidio,et al.  Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers’ Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care , 2016, PloS one.

[22]  J. Hirsch,et al.  The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. , 2016, AIDS patient care and STDs.

[23]  S. Finocchario-Kessler,et al.  Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities. , 2016, AIDS patient care and STDs.

[24]  A. Gardner,et al.  How has the profile of Australian nurse practitioners changed over time? , 2016, Collegian.

[25]  A. Nardone,et al.  Healthcare providers' knowledge of, attitudes to and practice of pre‐exposure prophylaxis for HIV infection , 2016, HIV medicine.

[26]  Sheena McCormack,et al.  Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial , 2016, The Lancet.

[27]  V. Patel,et al.  A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians , 2016, Journal of General Internal Medicine.

[28]  I. Wilson,et al.  Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England , 2015, PloS one.

[29]  Kimberly A. Koester,et al.  Client and Provider Perspectives on New HIV Prevention Tools for MSM in the Americas , 2015, PloS one.

[30]  R. Remien,et al.  PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives , 2015, Substance Abuse Treatment, Prevention, and Policy.

[31]  J. Wilton,et al.  Preparing for PrEP: Perceptions and Readiness of Canadian Physicians for the Implementation of HIV Pre-Exposure Prophylaxis , 2014, PloS one.

[32]  K. Mayer,et al.  HIV Providers’ Perceived Barriers and Facilitators to Implementing Pre-exposure Prophylaxis in Care Settings: A Qualitative Study , 2014, AIDS and Behavior.

[33]  C. Newman,et al.  No Ordinary Mainstream Illness , 2014, Qualitative health research.

[34]  J. Dovidio,et al.  The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access , 2014, AIDS and Behavior.

[35]  J. Wilton,et al.  Knowledge of and opinions on HIV preexposure prophylaxis among front-line service providers at Canadian AIDS service organizations. , 2013, AIDS research and human retroviruses.

[36]  Wayne T. Steward,et al.  A Qualitative Study of Provider Thoughts on Implementing Pre-Exposure Prophylaxis (PrEP) in Clinical Settings to Prevent HIV Infection , 2012, PloS one.

[37]  W. Duffus,et al.  Preexposure Prophylaxis for HIV Infection: Healthcare Providers’ Knowledge, Perception, and Willingness to Adopt Future Implementation in the Southern US , 2012, Southern medical journal.

[38]  S. Kippax.  Effective HIV prevention: the indispensable role of social science , 2012, Journal of the International AIDS Society.

[39]  J. D. de Wit,et al.  Australian Gay Men Who Have Taken Nonoccupational Postexposure Prophylaxis for HIV Are in Need of Effective HIV Prevention Methods , 2011, Journal of acquired immune deficiency syndromes.

[40]  J. D. de Wit,et al.  Rates of condom and non-condom-based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction? , 2011, Sexually Transmitted Infections.

[41]  David V Glidden,et al.  Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. , 2010, The New England journal of medicine.

[42]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[43]  S. Kippax,et al.  In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex , 2002, AIDS care.

[44]  G. Dowsett,et al.  Sustaining safe sex: a longitudinal study of a sample of homosexual men , 1993, AIDS.