Prescribing HIV pre-exposure prophylaxis: A qualitative analysis of health care provider training needs

Abstract

Increasing the number of pre-exposure prophylaxis (PrEP) prescriptions will require more health care providers to be willing and trained to prescribe the medication. The purpose of our study was to understand the training needs of clinicians who do not prescribe PrEP. From September 2017 to January 2018, qualitative interviews were conducted with providers who had no experience prescribing PrEP (N = 20). Thematic analysis revealed four themes: three emphasized the temporal nature of training requirements and one identified training preferences of providers. Study findings suggest that clinicians require specific information in order to integrate PrEP into their practices successfully.

Introduction

In recent decades, great strides have been made to reduce new HIV infections; however, recent data suggest that progress has begun to stall. From 2013 to 2016, HIV incidence in the United States has remained stable, with approximately 40,000 new infections reported each year (Centers for Disease Control and Prevention [CDC], 2019). In an effort to further reduce HIV transmission, the U.S. Food and Drug Administration approved pre-exposure prophylaxis (PrEP) in 2012 for adults (U.S. Department of Health and Human Services, 2012) and in 2018 for adolescents (U.S. Department of Health and Human Services, 2018). PrEP is a daily medication taken by HIV-uninfected individuals to reduce the risk of acquiring HIV. When taken regularly, PrEP has been shown to reduce the risk of acquiring HIV through sexual contact and intravenous drug use by more than 90% and 70%, respectively (CDC, 2018b). Although PrEP has been available in the United States for several years, fewer than 10% of those who meet eligibility guidelines have obtained a prescription (Siegler et al., 2018). As the number of new HIV infections remains relatively constant, there is a growing need to understand the mechanisms behind the slow uptake of PrEP.

Currently, PrEP is only available in the United States with a prescription from a health care provider; therefore, understanding provider perspectives regarding its use as an HIV prevention tool is integral to increasing uptake. While much is known about facilitators, barriers, and attitudes to prescribing PrEP among health care providers (Turner, Roepke, Wardell, & Teitelman, 2018), the extant research does not capture the growing need to understand provider training requisites for PrEP. Adequate training on PrEP for prescribers is key to improving uptake, and it is important that these training efforts reach health care providers with prescribing privileges. In the United States, providers with a medical degree (MD, DO) have the capacity to independently prescribe medications, including PrEP; however, prescribing authorities for nurse practitioners (NP) and physician assistants (PA) differ based on state (American Medical Association, 2018). Although variations exist, practitioners such as NPs and PAs typically have the capacity to prescribe medications, including PrEP, under physician supervision. Further, a growing body of evidence suggests that expanding PrEP training efforts to an array of provider types will assist with increasing the number of clinicians who are able and willing to prescribe PrEP to eligible patients.

Currently, there is limited research concerning PrEP training for health care providers. The few studies have primarily addressed this perspective through quantitative measures (Bacon et al., 2017; Clement et al., 2018; Wood et al., 2018) or have exclusively explored the perspectives of physicians (Calabrese et al., 2016). Bacon et al. (2017) surveyed 99 prescribing and non-prescribing PrEP providers in the San Francisco Bay Area regarding their attitudes toward PrEP and training needs. The authors illustrated that the majority sought training concerning HIV testing frequency (88%), laboratory monitoring (86%), contraindications (86%), PrEP eligibility (84%), and adherence monitoring (81%). Providers also indicated that in-person or web-based training methods would be acceptable ways to receive information. A qualitative study of 18 physicians who had adopted PrEP in their clinical settings described similar requisites. The majority emphasized the need for future training to incorporate web-based methods to disseminate information regarding HIV epidemiology, clinical PrEP protocols, and sexual history-taking (Calabrese et al., 2016).

While research has addressed training requisites for PrEP, to date, there is a dearth of literature that exclusively has explored the needs of non-PrEP prescribing providers in a variety of clinical settings, such as community-based health clinics and university-based health clinics, through qualitative methods or has examined specific needs from a wider variety of clinicians, such as NPs and PAs. As the majority of individuals who are eligible for PrEP receive care in these settings (CDC, 2018a), there is an increasing need to understand provider education concerns regarding their preparedness to prescribe PrEP. Complementarily, there is a desire to end the HIV epidemic by 2030, with a national goal to decrease new infections by 90% (Fauci, Redfield, Sigounas, Weahkee, & Giroir, 2019). Similarly, state health departments have highlighted the need to expand PrEP access to further reduce HIV incidence (Facente, 2016; Georgia Prevention and Care Council, 2016; New York State Department of Health [NYSDOH] AIDS Institute, 2019a). Such initiatives can only be accomplished by preventing transmission and subsequent infection. To achieve these goals, a greater number of providers must be trained and willing to prescribe PrEP in order to increase the number of active prescriptions for clinically-eligible patients. Therefore, provider-focused initiatives must emphasize the training needs of those who are not prescribing in order to increase PrEP uptake and decrease HIV transmission.

With such gaps in the literature and the need to fulfill government initiatives regarding HIV prevention and PrEP uptake, the purpose of our study was to qualitatively explore the training needs of prescribers in various health care settings. As PrEP-specific knowledge has been associated with higher instances of prescribing and intent to prescribe (Blumenthal et al., 2015; Krakower & Mayer, 2015; Mullins et al., 2017), it is important to understand the requisites of providers who have yet to implement PrEP into their clinical practices. By understanding such needs, initiatives can be tailored to increase knowledge among providers, thereby increasing the likelihood that they will prescribe PrEP to further aid in reducing new HIV infections.

Methods

Participant recruitment and procedures

Between September 2017 and January 2018, the New York State Department of Health PrEP/PEP (post-exposure prophylaxis) Voluntary Provider Directory, a publicly available public health resource, was used to recruit potential participants from two large counties (Erie and Niagara) in the state. Research team members contacted potential study participants via phone or email for study eligibility screening. Two screening questions were used to determine eligibility. Any individual who responded (a) “yes” to Are you currently a health care provider who has a license to prescribe medications?, and (b) “no” to Have you ever prescribed pre-exposure prophylaxis (also known as PrEP) to a patient? was eligible to participate and operationalized as a non-PrEP prescribing provider. Providers who had prescribed PrEP were excluded from the study. Of 61 providers contacted, 24 met eligibility criteria and 20 agreed to participate. Once enrolled, participants received an information sheet with a description of the study and were scheduled for an interview with a member of the research team.

In-depth interviews were conducted in English by trained members of the research team (two research assistants and the principal investigator) using a semi-structured interview guide; interviews occurred over the phone or in-person, depending on participant preference. Participants were first asked about demographic characteristics and clinical training experiences. An interview guide was then used to facilitate conversation regarding the potential adoption of PrEP, including perspectives on facilitators and barriers to PrEP uptake and training needs in order to implement PrEP in a clinical practice. Interviews continued until the research team agreed that data saturation was achieved. All participants received a $50 gift card upon completion of the interview. The university’s Institutional Review Board approved study procedures with a waiver for written informed consent.

Data analysis

Interviews were audio-recorded using two digital recorders, transcribed verbatim by a professional transcription service, and ranged in length from 13 to 46 minutes. Given the study’s interest in understanding provider training needs, participant responses to the following questions were analyzed and further detailed: (a) What do you think are the key prerequisites for providers to be able to implement the prescription of PrEP successfully?, (b) If you have an interest in prescribing PrEP in the future, what skills do you think you need to be able to successfully implement PrEP in your practice/clinic?, and (c) What should you know about PrEP, or what do you need to prescribe it?

An inductive thematic analysis was conducted to report semantic-level themes describing the PrEP training needs for our participants (Braun & Clarke, 2012). The analytic process commenced in Phase 1, with three researchers with experience in qualitative data analysis (1 doctoral student, 1 research coordinator, and the principal investigator) familiarizing themselves with the data. In Phase 2, two researchers (1 doctoral student and 1 research coordinator) read five transcripts to generate initial codes and develop a codebook. In Phase 3, the researchers independently coded the remaining transcripts and updated the codebook when new codes emerged. Coding discrepancies were discussed throughout all phases in consultation with the principal investigator to establish consensus. In the final phase of the analysis, researchers identified themes by collating relevant codes. In an effort to establish consistency of themes throughout the data analytic process, the three researchers met on a bi-weekly basis to discuss findings. All overarching themes and subthemes were discussed in detail, and representative quotes were selected for each theme that emerged. Microsoft™ Excel was used for data management in all phases.

The rigor and trustworthiness of the data were determined by criteria established by Guba (1981). To assess credibility, interviewers familiarized themselves with the semi-structured interview guide prior to engaging in data collection. Interviewers also completed post-interview assessments to appraise the authenticity of participant responses. Additionally, interviewers met weekly throughout the data collection phase for peer debriefing of completed interviews and to provide ongoing feedback. Dependability and confirmability were assessed through the stringent adherence to the approved study protocol and with thorough documentation during the entire data collection phase. Criteria were also assessed during the analysis phase, as the researchers met on a bi-weekly basis to discuss the accuracy and reliability of codes between investigators to build consensus.

Results

Participant characteristics

Twenty non-PrEP prescribing providers participated in the study, including nine physicians, seven nurse practitioners, and four physician assistants. Participant age ranged from 26 to 73 years (M = 42.4). The majority were female (85%), White (80%), and self-identified as primary care providers (65%). Most practiced in urban settings (75%) and had clinical experience with patients at risk for HIV, including people who inject drugs (95%), men who have sex with men (90%), transgender women (85%), and people who exchange sex for money or drugs (50%). Additional participant characteristics appear in Table 1.

Table 1.

Participant demographics and clinical practice characteristics (N = 20).

Characteristics	n (%)
Age [M(SD)]	42.4 (12.3)
Sex
Female	17 (85)
Male	3 (15)
Race
Asian	1 (5)
White	16 (80)
Other (Bi-racial, Egyptian, East Indian)	3 (15)
Professional degree
Doctor of Medicine (MD)	8 (40)
Doctor of Osteopathic Medicine (DO)	1 (5)
Nurse Practitioner (NP)	7 (35)
Physician Assistant (PA)	4 (20)
Years of clinical experience [M(SD)]	12.2 (11.1)
Practice setting
Academic Health Center	4 (20)
AIDS Service Organization	2 (10)
Community Health Center	5 (25)
Family Planning Clinic	1 (5)
Hospital	4 (20)
Physician Practice Group	2 (10)
Private Clinic	2 (10)
Other	2 (10)
Aware of PrEP prior to study	17 (85)
Clinical experience with at-risk groups
Men who have sex with men	18 (90)
People who exchange sex for money, drugs, etc.	10 (50)
People who inject drugs	19 (95)
Transgender women	13 (65)

Note. PrEP: pre-exposure prophylaxis.

Thematic analysis revealed four themes regarding training requirements for non-PrEP prescribing providers, three of which pointed to the temporal nature of preparation and maintenance needs: (a) pre-initiation training needs, (b) continual training needs, (c) post-initiation training needs, and (d) general training preferences. Exemplar quotes for each theme and subtheme appear in Table 2.

Table 2.

Key themes regarding training needs for pre-exposure prophylaxis.

Theme	Sub-theme	Illustrative quote
Pre-initiation training needs	Basic PrEP information and prescribing practices	“They need to understand the whole concept of why it’s being prescribed.” (61-year-old NP)
	PrEP candidacy	“The correct risk factors to ask and assess, so that even if a patient doesn’t know about PrEP, you [can] see this patient and know they would be a good candidate for this.” (26-year-old NP)
	Patient engagement in PrEP care	“Being able to explain to the patient, like what the meds are and how to properly take them and still encourage them to obviously still protect themselves in other ways. But that PrEP is just an added level of protection for them. So, I think that they should be able to adequately explain and educate the patient about the applications, the mechanisms and the proper procedure.” (31-year-old MD)
Ongoing training needs	Medication characteristics	“…The side effects [so] that we can counsel the patients on options of treatment we can do for the side effects.” (40-year-old NP)
	Laboratory work	“…In terms of checking on labs, you want to make sure, you’re checking the labs, you know regularly that they don’t really have any renal dysfunction [and] that they’re HIV negative.” (51-year-old MD)
Post-initiation training needs	Patient follow-up and monitoring	“…The follow-up care: what testing needs to be done? When [it needs to be done]? What to watch for?” (36-year-old PA)
	Ongoing patient counseling	“I’d like to be able to answer questions that other patients have already had or problems that they would be encountering like the side effects of the medication, if any, how to best answer those questions to give the patient reassurance that it’s going to get better, don’t stop taking the medicine, it’s going to get better.” (60-year-old PA)
General training preferences		“I probably would want someone in-person so I could see exactly what it is that that individual does, what are the steps because like I said, I prefer algorithms so that I know that I’m following all the steps and protocols appropriate. And then how is it that they do it? Do they do the lab work? Do they have the patient fill out forms? How is it that everything gets done in such a systematic way that it’s successful?” (54-year-old NP)

Pre-Initiation training needs

Providers highlighted critical preparatory information needed prior to PrEP initiation with patients. Participants identified key areas of training needed to become confident in PrEP discussions and prescribing, including: (a) basic PrEP information and prescribing practices, (b) PrEP candidacy, and (c) patient engagement in PrEP care.

Basic PrEP information and prescribing practices

Although the majority of our sample was aware of PrEP (85% had heard of PrEP prior to study enrollment), many providers stated that they lacked considerable knowledge about the medication. Providers discussed the receipt of training and how it would need to outline information about the epidemiologic role of PrEP in preventing HIV and information about how the medication functioned to prevent HIV infection. Participants felt that receiving comprehensive education about the use of PrEP as a biomedical HIV prevention strategy would serve as a stepping stone to prescribing and would allow them to not only become more familiar with the medication, but to also become aware that they could offer PrEP to their patients.

Similarly, participants described the need to learn about prescribing guidelines for PrEP. This included information about prescribing schedules, duration of therapy, and pharmacy availability. Although participants discussed the need to be knowledgeable on all of these topics, many highlighted the importance of understanding insurance coverage for PrEP. Due to the wide range of health insurance plans and programs available to patients, providers indicated that trainings should emphasize the extent to which insurance options covered the medication and the availability of resources to subsidize medication for eligible patients in need of financial assistance. Providers indicated that by learning these aspects of the prescribing process, they would better understand the clinical protocols and guidelines for PrEP and feel adequately prepared to offer it to their patients.

PrEP candidacy

Providers highlighted the need to be able to identify patients who would be ideal candidates for PrEP. This included receiving information on which patients were most at risk for acquiring HIV and behavioral risk factors indicating PrEP eligibility. Participants discussed the importance of training on HIV risk assessment and the need to use a comprehensive screening questionnaire with patients to help identify eligible patients. Providers stated that such tools would assist with identifying patients who meet eligibility criteria for PrEP. As the majority of this sample indicated clinical experience with populations that met eligibility criteria for PrEP, training on such guidelines would increase providers’ ability to identify and screen patients who could benefit from PrEP.

Patient engagement in PrEP care

While providers discussed the need to receive information about the prescribing process and PrEP candidacy, there was also the need to learn how to engage patients in thoughtful, deliberate conversations about PrEP. In these trainings, providers highlighted the need to be able to integrate PrEP into conversations with patients about sexual health. This suggestion included ways to incorporate PrEP into patient-centered discussions on particular risk behaviors, such as engaging in condomless sex with a partner of unknown HIV status. Equally important, providers indicated a need to learn effective techniques to explain how PrEP prevented transmission of HIV, and the importance of using PrEP in addition to other preventive measures, such as condoms, to decrease the risk of infection. Above all, providers acknowledged that this was a sensitive and potentially awkward conversation to have with patients and that learning strategies on how to approach these conversations in a non-judgmental way was essential to integrating PrEP into their practices.

Continual training needs

Providers discussed information that was not explicitly needed prior to, or after prescribing PrEP, but would be beneficial to know throughout the prescribing process. This training content included information about: (a) medication characteristics and (b) laboratory work.

Medication characteristics

Medication characteristics, including side effects and contraindications associated with PrEP, its pharmacology, dosing, and the types of medications used, was information providers described needing both before and after prescribing PrEP. To begin prescribing, providers highlighted the need to understand how PrEP worked, the medicines that comprised PrEP, dosing, and side effects associated with the medication. Having this information prior to writing a prescription was important to providers because they felt a responsibility to adequately educate patients. Concurrently, providers mentioned that being informed about side effects and contraindications was also needed after writing a prescription in order to counsel patients if such concerns arose. Nonetheless, training regarding PrEP was an ongoing requirement as providers needed to be able to accurately address medication-related questions from patients prior to writing a prescription and after prescribing in order to address contraindications and side effects that might emerge.

Laboratory work

Similarly, providers indicated that training regarding laboratory work required for PrEP was needed both before and after prescribing. Participants sought to know the tests to order and complete before writing a prescription, which would assist with their ability to initiate PrEP in their practices. Additionally, providers indicated that this need was required after a patient began PrEP to ensure that their patients remained appropriate candidates for the medication. Knowing the required laboratory tests before and after a patient received a prescription would help providers ensure that patients were eligible for PrEP and remained uninfected. Participants emphasized that understanding the different types of labs needed at each point of the prescribing process would allow them to implement PrEP more readily into practice.

Post-initiation training needs

Providers detailed training needed for maintaining patients on PrEP. These needs differed from those required to prescribe PrEP because patients would have already begun the regimen. Post-initiation training needs included information about: (a) patient follow-up and monitoring and (b) ongoing patient counseling.

Patient follow-up and monitoring

Providers indicated that they needed training on effective strategies for appropriate patient follow-up and monitoring, as they perceived this to be a critical component to ensure that patients remained adherent to the medication. Participants mentioned that they would require information about monitoring side effects, contraindications, and laboratory values. Along with monitoring adverse events and elevated laboratory values, providers emphasized the need to be trained on the frequency of HIV and sexually transmitted infection (STI) testing required at follow-up appointments. Similarly, providers highlighted the need for information about adherence, as many stressed that patient adherence to PrEP was a high priority.

Additionally, providers expressed the need for more logistical information about integrating PrEP into clinical practice. Because providers expressed concerns about assimilating PrEP follow-up appointments into their already busy schedules, many expressed interest in learning about ways to adapt current clinic flow to meet the needs of PrEP patients. This included learning the frequency and typical duration of follow-up appointments. Participants also valued receiving general monitoring and management skills to ensure that patients continued to take the medication and were retained in PrEP care.

Ongoing patient counseling

Providers sought guidance on how to effectively counsel patients about the medication, in addition to follow-up and monitoring, which included trainings on strategies to engage with patients about side effects, and how to manage patient concerns or problems related to taking the medication. As providers build their volume of PrEP patients, many mentioned that they could use these experiences to help facilitate conversations with patients, which could evolve into conversations regarding HIV prevention. Similarly, providers discussed that learning effective approaches to counsel patients would foster a strong patient-provider relationship, promote open communication, and enhance patient comfort. With these elements taken into consideration, providers indicated that they would be more equipped to educate and counsel patients on PrEP, while also focusing on the important role prevention has in maintaining overall health.

General training preferences

When asked about how providers wished to receive training on PrEP, the majority indicated that in-person trainings would be the most effective method. Providers emphasized the many benefits of in-person trainings that might not be possible in an online training. These trainings would allow inexperienced providers to address their concerns and ask questions in real-time. Whether providers had questions about the medication, prescribing protocols, or follow-up procedures, many indicated that they would feel more confident in their abilities to prescribe if they were able to speak with someone at an in-person training and understand how they had implemented PrEP into their practice.

Participants noted that busy schedules limited the ability to attend trainings during the workday; however, providers said they would be willing to attend trainings outside of their work schedules or to have brief didactic trainings during lunch hours. While the majority of participants discussed the benefits of receiving in-person trainings for PrEP, some preferred online trainings. Providers indicated that in-person trainings may not be necessary because they had already learned about the pharmacology of antiretroviral medications, but web-based trainings that provided an overview of the prescribing process and additional PrEP resources would be beneficial. Regardless of preferred learning modality, providers indicated that training for PrEP should encompass comprehensive information pertaining to pre-, continuing, and post-initiation needs. With these trainings, providers felt that they would be equipped with the information required to confidently and appropriately prescribe PrEP to eligible patients.

Discussion

Health care providers from various backgrounds and clinical settings are needed to increase the number of active PrEP prescriptions in the United States. In our qualitative study, non-PrEP prescribing providers discussed training needs in order to implement PrEP in their practices. Four themes emerged regarding non-PrEP prescribing provider training needs and general training preferences for PrEP.

To be confident in their ability to prescribe PrEP, providers indicated specific information that was needed prior to writing a prescription. Becoming knowledgeable about PrEP, its prescribing practices and candidacy, along with practices on how to engage patients in PrEP care, was considered by study participants to be necessary information needed to begin prescribing. Consistent with our findings, studies assessing prescriber PrEP adoption and training preferences have identified general knowledge about PrEP and its prescribing guidelines (Calabrese et al., 2016; Clement et al., 2018; Petroll et al., 2017), information about patient eligibility (Calabrese et al., 2016; Carnevale et al., 2019; Clement et al., 2018), and insurance coverage (Clement et al., 2018; Petroll et al., 2017) as training requisites for PrEP adoption. Study participants also highlighted not knowing how to engage patients in PrEP-related care, which could lead to missed opportunities to identify eligible candidates for PrEP. This included assessing sexual risk behaviors and candidacy for PrEP, a finding consistent with previous qualitative work exploring training recommendations from prescribing physicians (Calabrese et al., 2016). As the first step in the PrEP care continuum (Nunn et al., 2017), assessing a patient’s sexual risk behaviors is a key step in PrEP uptake. Therefore, to adequately incorporate PrEP into practice, providers must be trained to understand, identify, and assess risk behaviors that would indicate candidacy for PrEP, as literature has shown that providers who routinely assessed risk were able to more readily identify eligible patients and prescribe PrEP (St.Vil, Przybyla, & LaValley, 2019).

Our second theme emphasized continuing training needs, which included information about medication characteristics and laboratory work. These were highlighted as requisites needed throughout the entire prescribing process and not exclusively before or after initiating PrEP. Consistent with previous literature assessing provider knowledge of PrEP and recommendations for trainings (Bacon et al., 2017; Turner et al., 2018; Wood et al., 2018), providers in our study were interested in information about the side effects and contraindications of PrEP. While the probability of side effects and drug interactions is low, training providers to manage potential side effects of PrEP was key to increasing provider understanding of the medication. This would also provide them with the necessary information to alleviate concerns patients might have, either before beginning a prescription or after initiating a PrEP regimen.

Similarly, providers emphasized the need for information on the laboratory tests required for PrEP, a finding consistent with Bacon et al. (2017). In accordance with clinical guidelines, specific tests are required prior to beginning a PrEP prescription. To assess for candidacy, renal function and HIV tests are needed. Further, providers must follow-up with patients 3 months after prescribing, and every 6 months thereafter to assess renal function and test for HIV and other STIs (CDC, 2018b). Providing clinicians with this information during PrEP trainings would ensure that providers are able to effectively incorporate PrEP into their practices.

Our third theme emphasized the need for information that was pertinent after a provider begins prescribing. Information about follow-up and monitoring protocols, along with information on how to counsel patients while on PrEP were highlighted as post-initiation training requirements. In this study, providers mentioned that training about general monitoring and management skills would be valuable information, a finding consistent with other work (Carnevale et al., 2019; Petroll et al., 2017; Sullivan & Siegler, 2018). As patient-centered care takes into consideration the unique experiences of each patient, understanding monitoring and maintenance skills would ensure that patients remained adherent to the medication and follow-up regimen. Providers also wanted skills to counsel patients about their concerns related to PrEP. Consistent with work assessing current prescriber barriers to initiating PrEP-related conversations (St.Vil et al., 2019), providers in our study indicated that counseling patients was contingent on developing strong patient-provider relationships. By learning effective strategies for counseling patients regarding their PrEP-related concerns, providers would be able to cultivate these types of relationships, further fostering patient-centered care to ensure that patients were adherent to the medication.

Our final theme highlighted general preferences for PrEP-related trainings. Study findings indicated that in-person training was the primary method preferred by providers. Face-to-face trainings were indicated as most ideal, as providers would be able to ask specific, detailed questions and address concerns in real-time. Despite many providers being limited by demanding schedules, a unique finding in our study suggested that providers were willing to attend trainings outside of work schedules, including brief didactic trainings during lunch or after-office-hour sessions. Contrasting with the majority of our sample, yet consistent with previous research (Calabrese et al., 2016; Wood et al., 2018), some providers in our sample preferred self-directed, web-based trainings with the ability to address concerns in real or delayed time. Since providers in our study preferred both face-to-face and online trainings for PrEP implementation; public health detailing, a strategy that has previously been implemented for PrEP in New York City and New England health care practices (Ard et al., 2019), could be an ideal mechanism to train providers. PrEP health educators could be incorporated as an additional resource for providers, as they can disseminate information regarding the prescribing process and assist with engaging patients in PrEP care (Zablotska & O’Connor, 2017). Further, to accommodate busy provider schedules, providers could seek resources through the NYSDOH AIDS Institute Clinical Education Initiative (NYSDOH AIDS Institute, 2019b), and other online learning resources such as the University of California, San Francisco Clinical Consultation for PrEP (Clinical Consultation Center, 2019) to receive additional information regarding clinical decision-making for PrEP.

Limitations

Findings from our study should be considered in light of its limitations. First, our study relied on a convenience sampling strategy to recruit eligible participants. Second, our sample lacked diversity, as the majority were female and identified as White; therefore, our findings do not represent the full range of provider perspectives. Third, participants were primarily health care providers who worked in urban settings from two counties in western New York; therefore, our findings may not be transferable to other communities or clinical settings. Lastly, data analyzed for our study used semi-structured interviews to explore provider attitudes and perspectives on PrEP, which may present some social desirability bias. Despite these limitations, our study is among a burgeoning set of qualitative studies exploring training requisites for health care providers; thereby complementing previously existing quantitative work within the field.

Conclusion

Successful PrEP adoption among health care providers is reliant on receiving comprehensive training that supports provider readiness to prescribe and manage patients on the medication. Data suggest that non-PrEP prescribing providers require detailed information regarding the temporal nature of the preparation and maintenance needs of PrEP and indicate specific preferences for training modalities. Given that the majority of individuals who are eligible for PrEP do not have a prescription, it is essential to understand the training requisites of health care providers who are not currently prescribing PrEP in order to encourage the uptake of active PrEP prescriptions in the United States. Findings offer valuable insights on how targeted training can assist health care professionals with integrating PrEP into their clinical settings and engaging individuals at risk for HIV into preventive care. Future research should explore the impact of receiving educational trainings on providers’ willingness to prescribe PrEP and its effects on increasing active prescriptions among patients.