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Erschienen in: Current HIV/AIDS Reports 1/2021

08.01.2021 | Implementation Science (E Geng, Section Editor)

Patient-Led Decision-Making for HIV Preexposure Prophylaxis

verfasst von: Whitney C. Sewell, Patricia Solleveld, Dominika Seidman, Christine Dehlendorf, Julia L. Marcus, Douglas S. Krakower

Erschienen in: Current HIV/AIDS Reports | Ausgabe 1/2021

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Abstract

Purpose of Review

Shared decision-making is a process that involves bidirectional exchange of information between patients and providers to support patients in making individualized, evidence-based decisions about their healthcare. We review the evidence on patient-led decision-making, a form of shared decision-making that maximizes patient autonomy, as a framework for decisions about HIV preexposure prophylaxis (PrEP). We also assess the likelihood that patient-led decision-making occurs for PrEP and describe interventions to facilitate this process.

Recent Findings

Patient-led decision-making is likely to be uncommon for PrEP, in part because healthcare providers lack knowledge and training about PrEP. Few evidence-based interventions exist to facilitate patient-led decision-making for PrEP.

Summary

There is a need for rigorously developed interventions to increase knowledge of PrEP among patients and healthcare providers and support patient-led decision-making for PrEP, which will be increasingly important as the range of available PrEP modalities expands.
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Zurück zum Zitat • Skolnik AA, Bokhour BG, Gifford AL, Wilson BM, Van Epps P. Roadblocks to PrEP: What medical records reveal about access to HIV pre-exposure prophylaxis. J Gen Intern Med. 2020;35(3):832–8. https://doi.org/10.1007/s11606-019-05475-9. In this qualitative study of clinic notes from the Veterans Health Affairs system, nearly all (94%) of PrEP conversations were initiated by patients, one-third of patients experienced delays receiving PrEP, and 70% of patients faced barriers to accessing PrEP. Barriers to PrEP included provider knowledge gaps about PrEP, confusion or disagreement over clinic purview for PrEP, and stigma associated with patients seeking PrEP. These results indicate a need to improve providers’ skills in communicating with patients about PrEP and prescribing to those patients who decide to initiate PrEP. • Skolnik AA, Bokhour BG, Gifford AL, Wilson BM, Van Epps P. Roadblocks to PrEP: What medical records reveal about access to HIV pre-exposure prophylaxis. J Gen Intern Med. 2020;35(3):832–8. https://​doi.​org/​10.​1007/​s11606-019-05475-9. In this qualitative study of clinic notes from the Veterans Health Affairs system, nearly all (94%) of PrEP conversations were initiated by patients, one-third of patients experienced delays receiving PrEP, and 70% of patients faced barriers to accessing PrEP. Barriers to PrEP included provider knowledge gaps about PrEP, confusion or disagreement over clinic purview for PrEP, and stigma associated with patients seeking PrEP. These results indicate a need to improve providers’ skills in communicating with patients about PrEP and prescribing to those patients who decide to initiate PrEP.
73.
Zurück zum Zitat • Patel RR, Chan PA, Harrison LC, Mayer KH, Nunn A, Mena LA, et al. Missed opportunities to prescribe HIV pre-exposure prophylaxis by primary care providers in Saint Louis, Missouri. LGBT Health. 2018;5(4):250–6 This study found that nearly half of the patients seeking PrEP at an academic infectious diseases clinic in St. Louis, Missouri had previously asked their primary care providers about PrEP but were not prescribed it. These findings suggest that there are many missed opportunities for patient-led decision-making for PrEP in primary care.PubMedPubMedCentralCrossRef • Patel RR, Chan PA, Harrison LC, Mayer KH, Nunn A, Mena LA, et al. Missed opportunities to prescribe HIV pre-exposure prophylaxis by primary care providers in Saint Louis, Missouri. LGBT Health. 2018;5(4):250–6 This study found that nearly half of the patients seeking PrEP at an academic infectious diseases clinic in St. Louis, Missouri had previously asked their primary care providers about PrEP but were not prescribed it. These findings suggest that there are many missed opportunities for patient-led decision-making for PrEP in primary care.PubMedPubMedCentralCrossRef
Metadaten
Titel
Patient-Led Decision-Making for HIV Preexposure Prophylaxis
verfasst von
Whitney C. Sewell
Patricia Solleveld
Dominika Seidman
Christine Dehlendorf
Julia L. Marcus
Douglas S. Krakower
Publikationsdatum
08.01.2021
Verlag
Springer US
Erschienen in
Current HIV/AIDS Reports / Ausgabe 1/2021
Print ISSN: 1548-3568
Elektronische ISSN: 1548-3576
DOI
https://doi.org/10.1007/s11904-020-00535-w

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