We have a drug that protects from #HIV. True or False? #ph260720
My friend Steve texted me last year asking how he could convince his partner Ed to see a doctor.

Steve said, “Something weird is happening to him. He can’t walk, his speech is slurred, and his mood changes. He’s a totally different person.” #ph260720 #HIV
I asked him why Ed is reluctant to see doctors. Steve replied, “He has always hated seeing doctors because he feels judged by the health system.”

This is the story of Ed’s experience and how we could have prevented his death from #AIDS 8 weeks later. #ph260720 #providerbias
Going back to my poll question, the answer is True. The drug is called #PrEP (Pre-Exposure Prophylaxis). If properly used, #PrEP can prevent getting #HIV via sex/injection drug use. @CDC_HIV

But here’s the problem. #ph260720 Image
@CDCgov estimates that >1.2M people at risk for #HIV could benefit from #PrEP, but currently <6% are accessing it.

Why is that?

To answer this question, most studies have focused on at-risk people, but far fewer studies have focused on providers. #ph260720
‼️Astonishing facts‼️

@CDCgov >1/3 of primary care providers are unaware of #PrEP. And 60% of 271 US nurse practitioners had no prior #PrEP education. #ph260720
I found an eye-opening paper 👀@BUSPH_HLPM @dtdangerfield

The authors (Dr. Skolink, @BBokhour @allenlgifford) identified #PrEP access barriers in the VA health system by examining providers’ Electronic Health Records (#EHR). #ph260720

Here are some shocking findings:
1️⃣ >70% of patients experienced #PrEP access barriers.

2️⃣ Patients initiated 94% of #PrEP conversations and 35% of patients did not receive #PrEP from 6weeks to 16months.
Reasons include provider #KnowledgeGap & #providerstigma. #ph260720
@HIVMA This is what some physicians wrote on their #EHR:

“Patient ADMITS TO homosexual behavior.”

“Veteran UNWILLING to change behaviors.”

“[Told him #PrEP] is not […] for prevention”

#PrEP is effective only 50% of the time, maybe less.” #ph260720 Image
This research also revealed healthcare systems issues.

Lack of agreement among different departments on where to initiate #PrEP care led to care delays and multiple visits.

Patients were often “bounced back and forth between #primarycare and #HIV clinics.” #ph260720
As mentioned in the paper, the #PrEP access barrier would be much higher in real-world settings b/c the study participants 1) were already educated on #PrEP. 2) were ‘persistent advocates’ for #PrEP. #ph260720
The authors @BBokhour @allenlgifford raise a very pertinent question: What happens if the patients lack the time, energy, money, and education to persistently advocate for #PrEP? #ph260720
My take on this paper:

1) Provider capacity building is critical to address #KnowledgeGap and #bias. 💪

2) We need to design a streamlined #HIV prevention & care access to facilitate #PrEP initiation. #ph260720 Image
❗️Capacity building for #primarycare providers (PCPs) is especially important.

Most patients will visit the PCPs first to discuss #HIV prevention instead of infectious disease specialists.

So PCPs need to be ready to talk about #PrEP as first-line care providers. #ph260720 Image
We need to empower #physicians through feasible and easy #team-based interventions.

Good news is, we see some success examples in HIV training for residents. #ph260720

That said, the question about #bias training persists. To what extent is the education effective to address #providerbias?

Despite providers’ accurate #PrEP knowledge, their #stigma toward patients could still deter them from prescribing #PrEP. #ph260720
While changing providers’ subjective perspective toward patients is extremely challenging, it’s critical to remember that “Patients aren’t ‘risky’ - behaviors can be.” @DMalebranche

Here are the 6 recommended mental processes for providers. #ph260720 #PrEP #HIV
Lastly, this is a very elegant 30 seconds #SexEducation (@jjbrassington @ColinMooreII).

The 30 seconds might have saved the 29y/o Ed’s life.

Please share this with your healthcare provider friends and anyone at risk for #HIV. #ph260720

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