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Understanding the Evolving Role of Nurse Practitioners in HIV Pre-exposure Prophylaxis Care in the United States
21 Pages Posted: 10 Jul 2020
More...Abstract
Backgrounds: Although preexposure prophylaxis (PrEP) approved for primary HIV prevention by the Federal Drug Administration in 2012, the PrEP utilization has been suboptimal. Existing literature and programs underestimated the role of nurse practitioners (NP) in PrEP care implementation. This review aims to understand the current status regarding PrEP care implementation among nursing professionals in the United States.
Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, we conducted a comprehensive literature search using multiple databases to identify peer-reviewed articles that examined the role of NP in the PrEP care implementation.
Results: A total of 26 studies with 15,789 health professionals, including both nursing professionals (e.g., NP, registered nurse) and physicians, were included in the analysis. The pooled proportion of NP (18%; 95% CI=14%,24%), followed by physician assistants (6%; 95% CI=2%, 10%). Compared with physicians, the odds of prescribing PrEP to patients among NP were 40% (OR=1.40, 95%CI=1.02,1.92) times higher, while the likelihood of willingness of prescription was similar. On the other hand, odds of being aware of PrEP (OR=0.63, 95% CI=0.46, 0.87) was 37% less in nursing professionals than the odds among physicians.
Conclusions: With restrained PrEP awareness, NP had a higher likelihood of prescribing PrEP than physicians. Although the limited number and scope of existing studies constrained the generalizability of our findings, the pattern of PrEP care implementation among NP has been well-described for the first time. To achieve optimal PrEP care implementation in the U.S., NP should play an essential role in PrEP care implementation.
Funding Statement: The study was supported by the University of Rochester Center for AIDS Research (P30AI078498) and School of Nursing at University of Rochester Medical Center. The content is solely the responsibility of the authors and does not necessarily represent the sponsor who had no role in the design or conduct of the study, the writing of this report, or its submission for publication.
Declaration of Interests: No competing financial interests exist.
Keywords: Systematic review, meta-analysis, PrEP care implementation, Health professionals, United States
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