November 07, 2023

Strategies for APPs in Primary Care: Promoting PrEP Uptake Among Cisgender Women

Posted By: Anne Teitelman, PhD, FNP-BC, FANNP, FAAN

As a family nurse practitioner and a researcher at the University of Pennsylvania and Thomas Jefferson University in Philadelphia, my research focuses on cisgender women and pre-exposure prophylaxis (PrEP).

My team and I developed an intervention to promote PrEP uptake among cisgender women. By meeting these women in their community, we discussed with them the importance of primary care in their general health and took the opportunity to educate them on PrEP. We found that many of these women did not already know about PrEP, but once they learned about it, they were interested in it, and expressed enthusiasm at the idea of talking to their primary care provider (PCP) about it.

Common Barriers
We know that PrEP uptake among cisgender women is very low. In 2022, only 14.5% of women who could benefit from PrEP were prescribed it, and this is a medication that has been approved by the FDA for more than 10 years. Unfortunately, cisgender women are often not made aware of PrEP and its benefits. To illustrate this point, more than half (53%) of the women in our study did not know PrEP existed, prior to hearing about it from the study team.

What we did find during this work, however, is that many local PCPs—whom these women trusted and were already seeing—did not know much about PrEP themselves. As a result, the women would be referred elsewhere for PrEP, and often, they did not seek that additional care. The women expressed confusion as to why their PCP did not know about and could not provide PrEP.

The Critical Role of Primary Care
From that lesson, my team and I learned how important it is for PCPs to provide PrEP. And with the growing number of advanced practice providers (APPs) being patients’ PCP, it is especially important for these healthcare team members to be educated and able to provide PrEP education to their patients.

One of the first steps a PCP (or APP) can take is to make their female patients aware of PrEP, which should be a discussion point when talking about safe sex strategies. It is up to us, as PCPs, to be informed and then educate our patients.

According to the CDC guidelines for PrEP and the prevention of HIV infection, PCPs should be talking with all sexually active adolescents and adults about PrEP. Our role is not to figure out who would and would not benefit from PrEP, but rather we should be having conversations with all patients who are sexually active about what PrEP is and how it benefits each of them individually. In addition, when discussing the benefits of PrEP and whether it might be an option for your patients, PCPs should practice shared decision-making. This way, patients have a direct role in determining if PrEP is right for them.

A PCP can identify some of the reasons why women in general might want to use PrEP: for example, if a woman doesn’t know the HIV status of her partner and they are not using condoms or if she uses drugs or alcohol before sex, or if she doesn’t know if her partner has other partners. With such guidance from her PCP, conveyed in a nonjudgmental way, the woman can decide if she might benefit from PrEP.

Patient–Provider Discussion Points
Discussions about PrEP in primary care should be part of overall sexual health discussions. I have heard from women, in particular, who have concerns about potential adverse effects and their ability to remember to take a pill every day. In addition, some were worried about people judging them negatively for receiving PrEP. These are just some of the concerns PCPs can address up front with their patients.

Women may also have specific concerns about pregnancy or breastfeeding. We know that daily oral PrEP is safe during both pregnancy and breastfeeding, but injectable cabotegravir PrEP does not yet have sufficient data to promote its use among those who are pregnant or breastfeeding.

Before initiating PrEP, there are a series of lab tests that need to be done, including making sure patients test negative for HIV infection. Once those labs come back and it looks like a patient would be a good candidate for PrEP, it is important to discuss treatment adherence and the follow-up required with different PrEP options. If patients choose the daily pill, they need to know that truly taking it every day is critical to ensure full protection against HIV, and for those who choose the injectable, they need to know how often to return to the clinic for their injections and what the dosing window is to ensure continued protection.

A Multidisciplinary Approach to Care
Much of this counseling and education can be delegated to other members of the healthcare team, such as a PrEP counselor, nurse, or medical assistant. These individuals can be trained to help with some of this work so that patients’ visits are more efficient for them and their PCP. This information can be given ahead of time, so the PCP can focus much of their time on the more complex decision-making that is within their skillset.

It is possible that some women see their PCP as their sole healthcare provider. If that PCP and team are not talking with them about PrEP, that is a missed opportunity for prevention. The CDC now recommends this education as a component of routine, preventive care.

Because covering all the basic preventive measures that are now recommended can be time consuming, a team-based approach can be helpful. The practice can have videos playing in the waiting room or educational brochures sitting on tables for patients to access. Staff should help out with spreading some of the more basic information to women before they talk with their PCP. I think these strategies will make it easier and, of more importance, doable to address PrEP and other prevention measures within the primary care setting.

Filed under: Infectious Diseases , Women's Health , Preventive Medicine , Public Health , NPs & PAs

June 27, 2024

HIV Prevention and Testing Is Not Bound By Age

Posted By: Jeffrey Kwong, DNP, MPH, AGPCNP-BC, FAANP, FAAN, AAHIVS, ACRN

In 2006, the CDC updated the HIV testing guidelines to recommend routine opt-out testing for people ...

Filed under: Infectious Diseases, Preventive Medicine, Public Health, NPs & PAs

May 02, 2024

Addressing ASCVD Risk in HIV: An Update to the DHH ...

Posted By: Jeffrey Kwong, DNP, MPH, AGPCNP-BC, FAANP, FAAN, AAHIVS, ACRN

The incidence of atherosclerotic cardiovascular disease (ASCVD) is estimated to be twice as high in ...

Filed under: Infectious Diseases, Preventive Medicine, Public Health, Cardiometabolic, NPs & PAs

March 21, 2024

Doxy-PEP: A New Opportunity to Reduce STIs

Posted By: Jeffrey Kwong, DNP, MPH, ANP-BC, ACRN

According to CDC data from 2022, more than 2.5 million cases of chlamydia, gonorrhea, and syphilis w ...

Filed under: Nurses Week, Infectious Diseases, Urology, Preventive Medicine, Public Health, Substance Abuse, NPs & PAs

January 09, 2024

Treatment of COVID-19: Practical Questions and Ins ...

Posted By: Renslow Sherer, MD

Is it reasonable to prescribe a 5-day supply of an oral antiviral to people traveling abroad with ri ...

Filed under: Infectious Diseases, Public Health, NPs & PAs

January 02, 2024

Assessment of COVID-19: Practical Questions and In ...

Posted By: Renslow Sherer, MD

How long should people isolate when they test positive for COVID-19?The CDC recommends that one shou ...

Filed under: Infectious Diseases, Public Health, NPs & PAs

December 19, 2023

Tackling Disparities in HIV Prevention

Posted By: Susan LeLacheur, DrPH, PA-C, AAHIVS

Racial and ethnic disparities have been a problem in the HIV epidemic since the very beginning. Rece ...

Filed under: Infectious Diseases, Women's Health, Preventive Medicine, Public Health, NPs & PAs

Clinical Education Alliance Terms and Conditions

These Terms of Use ("Terms") apply to your use of the websites, mobile applications and other resources provided by Clinical Education Alliance LLC (“CEA”) and its affiliates (referred to collectively as "CEA," "us," "we" and "our") that are intended for use by healthcare professionals, which we refer to as the "CEA Network," including the personalized information and services that meet the needs and interests of users of the CEA Network such as medical news, reference content, clinical tools, applications, sponsored programs, advertising, email communications, continuing medical education, market research opportunities and discussion forums (collectively, the "Services"). You will always be able to view the most current version of these Terms by clicking on the Terms of Use link at the bottom of any page of a CEA Network property. Note that these Terms do not apply to our properties and services that display a link to different terms of use. In the event that we expand the CEA Network through our acquisition of another company and/or its properties, that company may operate its properties subject to its own terms of use accessible via a link on such properties until we integrate its practices with ours, at which point a link to these Terms will be displayed on its properties. By using the Services, you agree to these Terms, whether or not you are a registered member of the CEA Network. These Terms govern your use of the Services and create a binding legal agreement that we may enforce against you in the event of a violation. If you do not agree to all of these Terms of Use, do not use the Services!

We reserve the right to change these terms from time to time. The most current version may be viewed by clicking on the “Terms of Use” link at the bottom of designated pages on the Clinical Education Alliance Sites. Use of the Clinical Education Alliance Sites after the effective date constitutes acceptance of the amended Terms of Use. When you leave a CEA Web site and go to another Web site, different terms apply and CEA has no responsibility or liability for any content on those sites.

Clinical Education Alliance Content

The Clinical Education Alliance Sites incorporate information, including modules, capsules, journal articles, medical news, references, interactive case studies, other continuing education material, downloadable software applications, advertising, and other healthcare information, which is intended for adults who are licensed healthcare professionals. This information is not intended to serve as a substitute for the healthcare professional’s clinical judgment. If you are a consumer who chooses to read this professional-level information on Clinical Education Alliance Sites, you should not use or rely on that information as professional medical advice or use it to replace any relationship with your physician or other qualified healthcare professional or any information they may have provided to you. For medical issues or concerns, including decisions about medications and other treatments, consumers should always consult their physician or, in serious cases, seek immediate assistance from emergency personnel.

The Content on the Clinical Education Alliance Sites is developed or selected in accordance with our published Editorial Policies. However, users access and use this material at their own risk. It is the reader’s job to evaluate the accuracy of any information and results from interactive programs found on the Clinical Education Alliance Site. If you are a healthcare professional, you should rely on your professional judgment in evaluating any and all information and confirm the information contained on the Clinical Education Alliance Sites with other sources and reliable third parties before basing any treatment or advice on it. If you are a consumer, you should evaluate the information together with your physician or another qualified healthcare professional.

DISCLAIMERS AND LIMITATIONS OF LIABILITY

THE CONTENT, APPLICATIONS, SOFTWARE, AND ALL OTHER MATERIAL ON THE CLINICAL EDUCATION ALLIANCE SITES ARE PROVIDED “AS IS” AND WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NONINFRINGEMENT. ALL WARRANTIES, EXPRESS OR IMPLIED, ARE HEREBY DISCLAIMED. CLINICAL EDUCATION ALLIANCE SHALL NOT BE LIABLE FOR ANY SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, INCLUDING, WITHOUT LIMITATION, PHYSICAL HARM OR INJURIES, LOST REVENUES, OR LOST PROFITS, RESULTING FROM THE USE OR MISUSE OF THE CLINICAL EDUCATION ALLIANCE SITES, OR ANY INFORMATION, APPLICATIONS, MATERIALS, OR SOFTWARE THEREON, EVEN IF CLINICAL EDUCATION ALLIANCE HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR FOR ANY CLAIM BY ANOTHER PARTY. CLINICAL EDUCATION ALLIANCE DOES NOT WARRANT THAT THIS SITE OR ANY APPLICATIONS OR SOFTWARE WILL BE FREE OF BUGS, INACCURACIES, OR ERRORS, NOR DOES CLINICAL EDUCATION ALLIANCE WARRANT THAT ANY SITE, SOFTWARE, OR APPLICATION IS FREE OF VIRUSES OR OTHER HARMFUL ELEMENTS.

A user’s use of the Clinical Education Alliance Sites, and any reliance on any materials, information, software, or applications, is at the user’s own risk. You agree that you hereby release Clinical Education Alliance and its affiliates, owners, respective directors, officers, employees, advertisers, authors, and contributors from any and all liability or obligations arising from the use of the Clinical Education Alliance Sites. A user’s sole remedy for any problem or concern is to exit the Web site or application. You agree that you will indemnify and hold Clinical Education Alliance harmless for any loss, damages, or liability suffered by Clinical Education Alliance as a result of your use of any Clinical Education Alliance Site or material, application, information, or software thereon or your submission of any material to Clinical Education Alliance. Clinical Education Alliance reserves the right to restrict or limit access to this Web site.

CEA Programs, Tools, and Databases

The Clinical Education Alliance Sites include interactive programs, clinical tools, and databases intended for the use of healthcare professionals. These materials are not intended as professional advice or recommendations of particular products. Physicians and other healthcare professionals who use our interactive programs, tools, or databases should exercise their own clinical judgment as to the results. Consumers who use the tools or databases do so at their own risk.

Individuals with any type of medical condition are specifically cautioned to seek professional medical advice before beginning any sort of health treatment. For medical concerns or issues, including decisions about medications and other treatments, users should always consult their physician or other qualified healthcare professional.

Ownership of Clinical Education Alliance Sites—Copyright and Trademarks

The entire contents and design of the Clinical Education Alliance Sites, including the software applications, tools, and databases, are protected under US and international copyright laws. These materials are owned by CEA or its affiliates or are used with permission of their owners or as otherwise authorized by law. All rights are reserved, worldwide. You may look at the Clinical Education Alliance Sites, download individual articles or applications to your personal computer or handheld device, and print a reasonable number of pages for your own personal reference. You must not remove any copyright notices from our materials. We reserve all our other rights. This means you may not sell, rewrite, or modify any content or other material found on any Clinical Education Alliance Site, redistribute it, put it on your own Web site, or use it for any commercial purpose without our prior written authorization.

The names of the CEA products and services are protected by trademark laws in the United States. Any use of our trademarks or service marks requires prior written approval from CEA.

You may link to a CEA Web site if your Web site offers products, services, or information of interest to the professional healthcare community. You are not allowed to link to the Clinical Education Alliance Sites if you post illegal, obscene, or offensive content or if the link is likely to have a negative impact on CEA’s reputation. Any other use, such as framing any part of a CEA Web site or incorporating any CEA content into another Web site, product, or application, requires advance written permission from Clinical Education Alliance. Clinical Education Alliance assumes no responsibility for any Web sites or materials that are linked to Clinical Education Alliance Sites or materials.

Software Products and Applications

Clinical Education Alliance makes some software and accompanying documentation available for downloading from our Web sites and/or from iTunes. These materials are protected by copyrights under US and international law and are owned by Clinical Education Alliance or companies that have licensed the software to us. We do not transfer any ownership rights in software or documentation to you when you download it from our Web site and/or directly from iTunes. You may use the software and accompanying documentation for their intended purpose. You are not authorized to further copy or distribute the software and accompanying documentation, nor may you attempt to recreate or reverse engineer our software or applications. In addition, some software available for downloading from our Web sites and/or from iTunes is subject to US export controls. By downloading or using such software, you are representing to us that your download of such software complies with these controls.

US Government End Users

If you are affiliated with the US government, please note that the software and documentation available on our Web sites and/or directly from iTunes are “commercial items,” as that term is defined in 48 C.F.R. 2.101 (October 1995), consisting of “commercial computer software” and “commercial computer software documentation,” as such terms are used in 48 C.F.R. 12.212 (September 1995). Consistent with 48 C.F.R. 12.212 and 48 C.F.R. 227.7202-1 through 227.7202-4 (June 1995), all US government end users acquire the software and documentation with only those rights set forth herein.

Social Media, Message Boards, and Forums

Clinical Education Alliance offers users the opportunity to engage in social media interactions with both experts and other users of the sites. As with other online social media, users must exercise sound judgment in both the information that they post and in how they assess the postings of other users. As such, users are expected to adhere to the social media recommendations made by the American Medical Association when utilizing the social media capabilities of CEA sites. In particular, users must be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments and must not post identifiable patient information on CEA sites. In social media interactions, users must maintain appropriate boundaries of the patient–physician/care provider relationship in accordance with professional ethical guidelines just as they would in any other context. Users acknowledge that privacy settings are not absolute and that once on the Internet, content posted by them may be copied by third parties and republished out of the control of Clinical Education Alliance. Thus, users should routinely monitor their own Internet presence to ensure that the personal information and content that they post and, to the extent possible, that is posted about them by others is accurate and appropriate.

Users are expected to refrain from submitting comments or messages that are defamatory, hateful, or obscene or that harass others. Users may not impersonate any other person or violate any other person’s or entity’s legal rights or submit falsified credentials or experiences. Users agree that they will not submit any materials that violate or infringe any copyrights, trademarks, patents, trade secret, or other intellectual property rights of any third party. Clinical Education Alliance retains all copyrights in the content posted by users to its sites. Clinical Education Alliance may adopt additional rules to govern use of social media, message boards or forums, to which users will be subject.

Copyright and Other Legal Violations

If you believe that any material on this Web site infringes your copyright, please notify us as follows, under the Digital Millennium Copyright Act (“DMCA”). To notify us, the DMCA requires that you: 1. Send an email notice to Clinical Education Alliance at customersupport@clinicaloptions.com. 2. Include the following information in your email: a. Identify the copyrighted work(s) you claim is infringed; b. Identify the material you claim is infringing the copyright(s) and give enough information for Clinical Education Alliance to locate that material; c. Include a physical or electronic signature of the copyright owner or a person authorized to act on the copyright owner’s behalf (the “Claimant”); d. Include the Claimant’s name, address, and telephone number(s); e. Include a statement that the Claimant has a good faith belief that use of the disputed material is not authorized by the copyright owner or his agent; and f. Include a statement, under penalty of perjury, that the information in the notification of copyright infringement is accurate and that the Claimant is the copyright owner or is authorized to act on behalf of the copyright owner.

If you believe any content or material on the Clinical Education Alliance Sites violates any laws, please notify customersupport@clinicaloptions.com. Please include details about your concerns and an email address for contacting you.

Governing Law

Clinical Education Alliance controls the Clinical Education Alliance Sites from its offices in the state of Virginia in the United States of America. The Clinical Education Alliance Sites can be accessed from any of the United States and from other countries worldwide. Since the laws of each state or country may differ, both you and Clinical Education Alliance agree that the laws of Virginia, without regard to conflicts of laws principles, will apply to all matters relating to use of the Clinical Education Alliance Sites and materials, including software and applications.

Clinical Education Alliance makes no representation that materials on these sites are appropriate or available for use in countries aside from the United States. Accessing the Clinical Education Alliance Sites from territories where their contents are illegal is prohibited. Those who choose to access these sites from other locations do so at their own risk and are responsible for compliance with any and all applicable local laws or regulations.

Acceptance Procedure

By downloading or accessing materials on the Clinical Education Alliance Sites and/or directly from iTunes or registering with us, you agree to all the terms and conditions in this agreement, including the Terms of Use and Privacy Policy. If you disagree with any of these Terms of Use or Privacy Policy, please refrain from using the Clinical Education Alliance Sites or materials.

Privacy Policy

Because we provide education for healthcare professionals, we pay special attention to privacy issues. The purpose of our Privacy Policy is to identify the information we may collect about you, describe the uses we may make of your information and the security measures we take to protect it, and discuss your options for controlling your information. You can review our Privacy Policy by clicking on the “Privacy Policy” link at the bottom of designated pages on the Clinical Education Alliance Sites.

Disputes

If you fail to comply with these terms, we have the right to suspend or eliminate your account and remove any information you have placed on our site, including your registration information. We may also take any legal action we think is appropriate. If there is any dispute between us concerning this agreement or your use of any Clinical Education Alliance Site or materials or applications, we both agree to submit the dispute to nonbinding mediation, followed by binding arbitration. Both the mediation and the arbitration will be governed under the rules of the American Arbitration Association, and the venue for the arbitration will be Virginia.

Questions or Concerns About Our Terms of Use

For questions or concerns about these Terms of Use, please send an email to customersupport@clinicaloptions.com

These terms of use were last updated in July 2021.