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Sexual Health Sexual Health Society
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RESEARCH ARTICLE

The PrEP resource: a mobile app for clinicians to facilitate screening, prescription and follow up of pre-exposure prophylaxis in the prevention of HIV

Michael Goldstein https://orcid.org/0000-0002-6190-6450 A * , Claire Sturek B , David Boedeker C and Katerina Shvartsman D
+ Author Affiliations
- Author Affiliations

A Department of Gynecologic Surgery and Obstetrics, Naval Medical Center Portsmouth, Portsmouth, VA, USA.

B Uniformed Services University School of Medicine, Bethesda, MD, USA.

C Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD, USA.

D Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD, USA.

* Correspondence to: mjgold326@gmail.com

Handling Editor: Cheng Wang

Sexual Health 21, SH24106 https://doi.org/10.1071/SH24106
Submitted: 25 April 2024  Accepted: 28 June 2024  Published: 22 July 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing

Abstract

Background

Over 2 million people worldwide receive a new HIV diagnosis annually. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission, but is underprescribed, including in the US. Lack of clinician comfort and knowledge are the most cited reasons for this discrepancy. We aimed to develop a mobile application (app) to address these barriers and improve patient access to PrEP.

Methods

We established key criteria to develop a point-of-care app that could be utilised in low-resource settings by various clinicians poised to prescribe PrEP therapy. The app underwent two rounds of beta testing and improvement utilising anonymous survey feedback from US physicians in 2023.

Results

The PrEP Resource tool was developed. Eleven physicians completed the initial survey addressing prescribing practices and app functionality. A total of 27% (3/11) of participants were uncomfortable prescribing PrEP, with the most common reasons being lack of training, unfamiliarity with guidelines and infrequently prescribing the medication. Our follow-up survey, completed by eight physicians, showed that 100% of participants found the app easy to learn and comprehensive enough to initiate PrEP.

Conclusion

Clinician discomfort due to lack of knowledge and familiarity is the most common reason for not prescribing PrEP. The PrEP Resource is a free tool that guides healthcare professionals through common clinical scenarios regarding PrEP therapy and may improve clinician comfort levels. It can be used in low-resource and low-bandwidth settings typically encountered in lower-middle-income countries where HIV prevalence is the highest. Further study is required to validate its usefulness across different settings.

Keywords: app development, decision support systems, healthcare technology, HIV prevention, medical education, mobile applications, physician practice patterns, point of care tools, pre-exposure prophylaxis, prescriptions.

References

Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367(5): 399-410.
| Crossref | Google Scholar |

Riddell J, IV, Amico KR, Mayer KH. HIV preexposure prophylaxis. JAMA 2018; 319(12): 1261.
| Crossref | Google Scholar | PubMed |

Volk JE, Marcus JL, Phengrasamy T, et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clin Infect Dis 2015; 61(10): 1601-1603.
| Crossref | Google Scholar | PubMed |

Centers for Disease Control and Prevention. HIV surveillance report. Centers for Disease Control and Prevention; 2020.

Mayer KH, Agwu A, Malebranche D. Barriers to the wider use of pre-exposure prophylaxis in the United States: a narrative review. Adv Ther 2020; 37(5): 1778-1811.
| Crossref | Google Scholar | PubMed |

Mullins TLK, Idoine CR, Zimet GD, Kahn JA. Primary care physician attitudes and intentions toward the use of HIV pre-exposure prophylaxis in adolescents in one metropolitan region. J Adolesc Health 2019; 64(5): 581-588.
| Crossref | Google Scholar |

Newman R, Katchi T, Karass M, et al. Enhancing HIV pre-exposure prophylaxis practices via an educational intervention. Am J Ther 2019; 26(4): e462-e468.
| Crossref | Google Scholar | PubMed |

Krakower DS, Mimiaga MJ, Rosenberger JG, et al. Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site. PLoS ONE 2012; 7(3): e33119.
| Crossref | Google Scholar |

Jones JT, deCastro BR, August EM, Smith DK. Pre-exposure prophylaxis (PrEP) awareness and prescribing behaviors among primary care providers: docstyles survey, 2016–2020, United States. AIDS Behav 2021; 25(4): 1267-1275.
| Crossref | Google Scholar | PubMed |

10  Pleuhs B, Quinn KG, Walsh JL, Petroll AE, John SA. Health care provider barriers to HIV pre-exposure prophylaxis in the United States: a systematic review. AIDS Patient Care STDS 2020; 34(3): 111-123.
| Crossref | Google Scholar | PubMed |

11  Watson HA, Tribe RM, Shennan AH. The role of medical smartphone apps in clinical decision-support: a literature review. Artif Intell Med 2019; 100: 101707.
| Crossref | Google Scholar |

12  Prescott O, Millar E, Nimmo G, Wales A, Edgar S. 21st century medical education: critical decision-making guidance through smartphone/tablet applications – the Lothian pilot. BMJ Simul Technol Enhanc Learn 2017; 3(2): 60-64.
| Crossref | Google Scholar |

13  Jhpiego Corporation. HIV Oral PrEP. (Version 1.1.8) [Mobile App]. App Store; 2023. Available at https://apps.apple.com/us/app/hiv-oral-prep/id1233271674

14  UCSF. HIV Care Tools. (Version 1.3.4) [Mobile App]. App Store; 2023. Available at https://apps.apple.com/us/app/hiv-care-tools/id1551420790

15  Challacombe SJ. Global inequalities in HIV infection. Oral Dis 2020; 26(S1): 16-21.
| Crossref | Google Scholar |

16  Meyer AJ, Armstrong-Hough M, Babirye D, et al. Implementing mHealth interventions in a resource-constrained setting: case study from Uganda. JMIR mhealth uhealth 2020; 8(7): e19552.
| Crossref | Google Scholar | PubMed |

17  US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States - 2021 update a clinical practice guideline. US Public Health Service; 2021.

18  Committee on Gynecologic Practice. ACOG committee opinion no 595: committee on gynecologic practice: preexposure prophylaxis for the prevention of human immunodeficiency virus. Obstet Gynecol 2014; 123(5): 1133-1136.
| Crossref | Google Scholar |

19  Liang JJ, Tsou C-H, Dandala B, et al. Reducing physicians’ cognitive load during chart review: a problem-oriented summary of the patient electronic record. AMIA Annu Symp Proc 2022; 2021: 763-772.
| Google Scholar | PubMed |