Integrating HIV prevention into routine health obstetric and gynecologic care.

Abstract

There is low uptake of PrEP for women. This study aims to understand the barriers and facilitators to improving PrEP uptake and integrating PrEP care into obstetric and gynecologic (OBGYN) care. We used the consolidated framework for implementation research (CFIR 2.0) to guide our approach. We conducted semi-structured interviews with OBGYN professionals, medical directors, and PrEP navigators. Participants were recruited via emails and purposeful sampling. Between May and December 2023, we completed 16 interviews. All participants heard of oral PrEP and felt that HIV prevention was within their scope of practice, but very few were prescribing PrEP. On a scale of 1-10 with 10 being most comfortable, the average comfort level identifying PrEP candidates was 6.96 (SD 1.91), but comfort prescribing PrEP was 6.11 (SD 2.51). Barriers to PrEP included insurance considerations, a lack of clinic infrastructure to support PrEP prescription and monitoring, and discomfort with prescribing PrEP (Individual). Key facilitators were PrEP stewards, professional and patient PrEP awareness and knowledge. Proposed strategies to increase PrEP uptake included PrEP education, workflow improvements, and utilizing the electronic medical record for HIV screening and PrEP care. Addressing multilevel barriers and facilitators can help increase PrEP uptake in the OBGYN setting.