Australian interdisciplinary healthcare providers’ perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study
Mattea Lazarou A , Lisa Fitzgerald A , Melissa Warner B , Sandra Downing C , Owain D. Williams A , Charles F. Gilks A , Darren Russell D E and Judith A. Dean
A F
+ Author Affiliations
- Author Affiliations
A School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia.
B Blood Borne Virus and Sexually Transmissible Infection Unit, Communicable Disease Branch, Queensland Health, Butterfield Street, Herston, Qld 4006, Australia.
C College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Douglas, Qld 4811, Australia.
D Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, 381 Sheridan Street, Cairns North, Qld 4870, Australia.
E College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Qld 4811, Australia.
F Corresponding author. Email: j.dean4@uq.edu.au
Sexual Health 17(6) 485-492 https://doi.org/10.1071/SH20156
Submitted: 25 August 2020 Accepted: 18 September 2020 Published: 9 December 2020
Abstract
Background: The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers’ (HCP) knowledge and preparedness to prescribe PrEP remains limited. Methods: Semistructured interviews, conducted before PBS listing (October 2016–April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. Results: Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia’s universal healthcare insurance system). Conclusions: Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.
Keywords: health services, HIV/AIDS, HIV prevention, PrEP, prevention, public health.
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