Pre-exposure Prophylaxis (PrEP) Discontinuation (1 CE)

Number of Credits: 1 CE credit

This course is for: Clinical psychologists, Counselors, LMFTs, and Nurses

Course By: Michael Parent, PhD

Content By: Whitfield, T. H. F., John, S. A., Rendina, H. J., Grov, C., & Parsons, J. T. (2018). Why I quit pre-exposure prophylaxis (PrEP)? A mixed-methods study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS and Behavior, 22, 3566-3575. doi: 10.1007/s10461-018-2045-1

Course Description: Pre-exposure prophylaxis (PrEP) is a medication that is 92-99% effective in preventing HIV, but the majority of PrEP research focuses on uptake of PrEP, not discontinuing it. The researchers assessed use and discontinuation of PrEP using qualitative and quantitative methods among a sample of 1071 gay, bisexual, and other men who have sex with men (GBMSM). People who were prescribed and then discontinued PrEP were more likely to be younger, without medical insurance, and unemployed. Reasons for discontinuing PrEP use included perceived lower HIV risk, cost and insurance concerns, medication side effects, and difficulty adhering to the PrEP regimen. GBMSM who reported discontinuing PrEP due to reduction in high risk behaviors mentioned intention to resume PrEP use if they resumed high risk behaviors, but GBMSM who reported discontinuing PrEP due to side effects did not mention resuming PrEP use. Future research may explore the criteria GBMSM use to place themselves in high risk status and potentially restart PrEP.

Learning Objectives:

1. Identify four previously published barriers to initial PrEP uptake discussed by the researchers and discuss the primary reason for reinitiating PrEP use after stopping use.
2. Identify two key findings presented by the researchers.
3. Identify three limitations of the presented study and discuss those limitations in the context of future research in this area.

Course Outline:

1. Read and understand Why I quit pre-exposure prophylaxis (PrEP)? A mixed-methods study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men.
2. Review the Course Description and Learning Objectives.
3. Review the summary of what PrEP is and why some patients may stop taking PrEP.
4. Complete the post-test questions. Recall that answers should be based on the referenced article.
5. Return to the referenced article for any missed questions and/or to understand reasons for PrEP discontinuation.

Implicit biases incorporate an association that occurs outside of conscious awareness that may resultantly lead to a negative patient evaluation derived from irrelevant characteristics; i.e. gender and/or race. A systematic review of the literature was conducted. Thirty-five studies identified the existence of implicit bias in healthcare professionals; all correlational studies evidenced a significant positive relationship between implicit bias levels and lower quality of care (FitzGerald & Hurst, 2017). Continued research in health care settings, combined with greater method homogeneity, should be employed to examine the occurrence and prevalence of implicit biases in healthcare settings as a strategic approach for mitigating related disparities (FitzGerald & Hurst, 2017).

Reference

FitzGerald, C., Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18, 19. https://doi.org/10.1186/s12910-017-0179-8

Approvals: