According to a recent study published in the American Journal of Obstetrics & Gynecology, a preexposure prophylaxis nurse increases HIV prevention discussion rates, but does not increase rates of preexposure prophylaxis prescription.
Takeaways
- Preexposure prophylaxis nurses can effectively increase HIV prevention discussions among cisgender women, as shown in the study.
- Despite increased discussion rates, the study did not find a corresponding increase in preexposure prophylaxis prescription rates among US women.
- Preexposure prophylaxis is effective at preventing HIV, but its prescription rates among cisgender women in the US remain low.
- The study utilized electronic medical record tools and trained nurses to counsel patients, resulting in a significant increase in discussions about preexposure prophylaxis.
- To improve preexposure prophylaxis prescription rates, persistent interventions and strategies may be needed beyond nurse-led discussions.
About 1 in 5 new HIV diagnoses in the United States are reported in cisgender women, with 85% attributed to heterosexual contact. While preexposure prophylaxis is effective at preventing HIV, rates of preexposure prophylaxis prescription among US women are low.
Investigators conducted a study to increase preexposure prophylaxis discussion and prescription rates among cisgender women. Three obstetrics and gynecology clinics were included in the study.
The study was divided into 3 phases, the first of which was the baseline phase. This phase covered the 3-month period before the clinical trial when provider training and nurse education about preexposure prophylaxis occurred.
The second phase was the clinical trial phase, covering the 3 months when participants were randomized to an active control or preexposure prophylaxis registered nurse intervention group. The final phase was the maintenance phase, covering the 3 months following the end of the trial.
Electronic medical record clinical decision support tools wereutilized to determine best practice alerts, progress note templates, order sets, and patient-focused preexposure prophylaxis education materials. Patients in the intervention group were counseled by a trained preexposure prophylaxis nurse.
The primary outcome of the study was the effectiveness of the intervention, measured as the rate of patients with documented HIV prevention counseling. Secondary outcomes included the reach, adoption, and maintenance of each phase.
There were 904 participants included in the analysis, aged a mean 28.8±7.7 years. Of these patients, 46% were pregnant and 436 were randomized in the clinical trial phase. The best practice alerts for reach and adoption were triggered for 100% of cases, but providers only acted on 52%.
Successful contact by the preexposure prophylaxis nurse was reported among 81.2% of patients. A significant increase in patients counseled about preexposure prophylaxis was seen in the registered nurse group vs the active control group, at 66.5% and 12.3% respectively. However, preexposure prophylaxis prescriptions did not differ between both groups.
A preexposure prophylaxis prescription was reported in 18.5% of patients counseled about preexposure prophylaxis in the intervention group and 3.4% counseled about preexposure prophylaxis in the control group. Significant differences were not observed in preexposure prophylaxis prescriptions across the 3 phases.
These results indicated increased HIV prevention discussions from a preexposure prophylaxis nurse, but not an increase in preexposure prophylaxis prescriptions. This suggests effects should be maintained through persistent interventions.
Reference
Wang R, Fruhauf TF, Sao SS, Gingher EL, Martin SJ, Coleman JS. Clinic-based interventions to increase preexposure prophylaxis awareness and uptake among United States patients attending an obstetrics and gynecology clinic in Baltimore, Maryland. Am J Obstet Gynecol. 2023;229(4):423.e1-423.e8. doi:10.1016/j.ajog.2023.07.046
