Identifying Provider-Level Barriers to Provision of PrEP Services for Cisgender Women: Application of the Disclosure Decision-Making Model.

Abstract

HIV pre-exposure prophylaxis (PrEP) is highly effective but underutilized by cisgender women. Physicians are important gatekeepers to PrEP access. Factors that shape providers' decisions to discuss PrEP with female patients are not well elucidated in the literature. We sought to understand these decisions through the lens of the Disclosure Decision-Making Model because discussion of PrEP with a patient shares many commonalities with HIV status disclosure. We interviewed physicians caring for women in HIV endemic regions in the US (N = 21). When adapted to reflect the clinical context, the DD-MM was well suited to characterize the factors influencing providers' willingness to disclose PrEP information. Assessments of information, receiver, clinical recommendation, and efficacy of disclosure-shaped providers' decision to disclose. We describe the unique considerations and articulate theoretical and practical implications to inform the development of interventions to improve equity in PrEP provision.