Determinants of Familiarity and Experience with HIV Pre-Exposure Prophylaxis in Primary Care Providers in Ontario, Canada

Abstract

Background: Despite increased access to HIV pre-exposure prophylaxis (PrEP) in Canada, familiarity and experience among primary care providers (PCPs)-including family doctors and those working with key populations-remains limited. To understand the barriers and facilitators of PrEP familiarity and experience, we conducted a situational analysis in PCPs in sub-urban and rural Ontario.

Methods: We surveyed a non-probabilistic sample of PCPs using an online questionnaire, designed with the Consolidated Framework for Implementation Research (CFIR). Poisson regressions with robust variance were used to assess the relationship between CFIR domains, sociodemographic, and practice characteristics on both PrEP familiarity and experience.

Results: A total of 54 PCPs participated (6% response rate), comprising 80% physicians and 20% nurses. Nearly 30% of the sample worked with key populations, including sexual health clinics and community care centers, 18% of respondents reported high familiarity with PrEP, and 44% reported PrEP experience (referred, started a conversation, or prescribed). PrEP familiarity and experience were associated with working in an organization serving key populations, working with gender minorities, and having colleagues providing PrEP. Providers with a positive perception of PrEP and its necessity for populations at risk were more likely to have PrEP-related experience. Higher familiarity and experience were reported by PCPs with specific clinical skills related to PrEP, and with the perception that PrEP was compatible with their practice as primary provider.

Conclusions: Our findings suggest that organizational support, and additional training and education would facilitate PrEP provision by PCPs in suburban/rural Ontario.

Keywords: HIV pre-exposure prophylaxis (PrEP); HIV prevention; implementation science; primary care providers (PCPs).

Figure 1.

Plot of attitudes toward characteristics of PrEP, Familiarity and Experience with PrEP. The CIBER is a data visualization method that presents different information on a diamond plot to facilitate the selection of the sub-determinants for intervention development. The diamond plot is divided into left-hand panel and right-hand panels with diamonds. One diamond shape in the left-hand panel represents both the means of the sub-determinants (in this study, the CFIR items) and its 99.99% confidence interval, while each diamond in the right-hand panel presents the associations (e.g., correlation) between each of the CFIR items and the outcome variable (in this study the experience with PrEP) with a 95% confidence interval. The dots around the left-hand panel diamonds are all the participants’ item scores.

Figure 2.

(a) Plot of attitudes toward population needs, Familiarity, and Experience with PrEP and (b) plot of concerns about the use of PrEP, Familiarity, and Experience with PrEP.

Figure 3.

Plot of inner settings domain, familiarity and experience with PrEP.

Figure 4.

(a) Plot of skills, familiarity, and experience with PrEP, (b) plot of ability or self-efficacy, familiarity and experience with PrEP, and (c) plot of beliefs about consequences, beliefs about compatibility, Familiarity, and Experience with PrEP.