Provider views of pre-exposure prophylaxis (PrEP) for cisgender women – where do women fit in HIV elimination in Australia?

Caroline Lade; Catherine MacPhail; Alison Rutherford

doi:10.1071/SH23163

RESEARCH ARTICLE (Open Access)

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Provider views of pre-exposure prophylaxis (PrEP) for cisgender women – where do women fit in HIV elimination in Australia?

Caroline Lade

^A , Catherine MacPhail

^B ^* and Alison Rutherford

^A

+ Author Affiliations

- Author Affiliations

^A Illawarra Shoalhaven Local Health District, Illawarra Shoalhaven Sexual Health Service, Port Kembla Hospital, Cowper Street, Warrawong, NSW, Australia.

^B University of Wollongong, School of Health and Society, Building 29, Northfields Avenue, Wollongong, NSW, Australia.

^* Correspondence to: cmacphai@uow.edu.au

Handling Editor: Anthony Smith

Sexual Health - https://doi.org/10.1071/SH23163
Submitted: 8 February 2023 Accepted: 9 October 2023 Published online: 31 October 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

HIV pre-exposure prophylaxis (PrEP) in Australia has largely been targeted at gay, bisexual and other men who have sex with men. In the context of HIV elimination, the aim of this qualitative study was to explore PrEP prescribing for Australian cisgender women from the provider’s perspective.

Methods

Semi-structured interviews were held with Australian prescribers in 2022. Participants were recruited through relevant clinical services, newsletter distribution and snowball sampling. Interviews were audio-recorded, transcribed and analysed thematically.

Results

Seventeen prescribers participated, of whom 9 were sexual health physicians and 10 worked in New South Wales. All reported limited clinical experience prescribing PrEP for women. Potential enablers to PrEP prescribing to women included education for women and clinicians, easily identifiable risk factors, individualised risk assessment and expansion of existing services. Barriers were limited PrEP awareness among women and prescribers, difficulties with risk assessment and consult and service limitations. The type of service recommended for PrEP provision varied among participants.

Conclusions

Clinician experience of PrEP prescribing to Australian cisgender women is limited, with substantial barriers to access perceived by prescribers. Targeted education to PrEP prescribers, updated national PrEP guidelines to include women as a distinct group and further research regarding women’s preferred model of PrEP access are required. Clarity of clinical ownership over PrEP implementation for women and, more broadly, women’s sexual health, is essential in order to achieve HIV elimination in Australia.

Keywords: Australia, general practice, HIV, implementation, pre-exposure prophylaxis, PrEP, prescribers, prevention, primary care, qualitative, sexual health, women.

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