HIV Pre-exposure Prophylaxis (PrEP) Practices in Florida, USA: Clinicians Perceptions of Initiation, Risk Identification, Barriers, and Facilitators

This study aimed to learn clinicians perspectives on PrEP initiation, the HIV risk assessment process, perceived barriers to PrEP implementation, and how a potential EHR-based PrEP clinical decision support (CDS) tool can help improve their practices. Data were collected between October 2021 and November 2021 via three remote focus groups with 15 clinicians with experience prescribing PrEP. The focus groups were audio recorded, transcribed, and analyzed using thematic analysis. Five themes emerged from the qualitative analysis: (1) PrEP initiation is a joint effort between patients and clinicians; (2) Electronic health records (EHRs) are helpful but insufficient for identifying PrEP candidates; (3) Patient-clinician conversations are key for identifying PrEP candidates; (4) Patient, clinician, and system-level barriers deter PrEP implementation; and (5) Adopting technological innovations in health care can improve PrEP prescribing. Our analysis suggests that implementing effective communication strategies and behavioral interventions can improve PrEP awareness and reduce barriers in patient-clinician discussions of sexual history and substance use.