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Publication Profiles

Health care providers’ decision-making and early adoption of tenofovir alafenamide for HIV preexposure prophylaxis: An inductive qualitative study

Citation

Merchant E, Solleveld P, Gibas K, Krakower D. Health care providers’ decision-making and early adoption of tenofovir alafenamide for HIV preexposure prophylaxis: An inductive qualitative study. PLoS One. 2024;19(12):e0311591. doi:10.1371/journal.pone.0311591

Implementation stage:

Implementation

Implementation outcomes reported:

Acceptability, Appropriateness, Adoption

Continuum target addressed:

PrEP initiation

Geography:

Non-priority jurisdiction

Study Participant Classification:

Providers

Plain Language Objectives

The researchers interviewed physicians about choosing between two oral HIV-prevention medications. They wanted to understand how eligibility, side effects, cost, experience, institutional guidance, advertising, and social influences shaped prescribing decisions.

Plain Language Abstract

Two oral medication combinations are available for pre-exposure prophylaxis, or PrEP, but they differ in approved populations, side effects, cost, and length of clinical experience. Researchers interviewed 21 resident, fellow, and attending physicians in internal medicine and infectious diseases between May 2020 and March 2021. Eighteen generally preferred tenofovir disoproxil fumarate with emtricitabine, two preferred tenofovir alafenamide with emtricitabine, and one had no preference. Providers viewed the medications as similarly effective. Decisions were shaped by whether a patient met each drug’s indication, different side-effect profiles, insurance and cost, prior experience, and personal preference. Respondents also described institutional guidance, advertising, peers, and colleagues as influences on clinicians and PrEP users. The findings suggest that neutral education could support evidence-based and cost-conscious choices. Because the study was qualitative and involved 21 physicians, it describes reported reasoning rather than actual prescribing patterns across the health system. It also does not determine which formulation produces better outcomes.

Key Takeaways

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