A Clinical Home for Preexposure Prophylaxis: Diverse Health Care Providers' Perspectives on the "Purview Paradox".

BACKGROUND One barrier to wider preexposure prophylaxis (PrEP) availability is uncertainty about the most appropriate providers and practice settings for offering PrEP. METHODS The authors conducted in-depth interviews with 30 clinicians--primary care and HIV specialists--in the New York City (NYC) region to explore issues related to PrEP rollout, including who should provide it and in what settings. RESULTS A diverse group favored offering PrEP in non-HIV specialty settings in order to reach high-risk HIV-negative individuals. Yet, for each clinical skill or ancillary service deemed important for providing PrEP--knowledge of the medications, ability to assess and counsel around sexual risk behavior, and ability to provide support for retention and medication adherence--participants were divided in whether they thought primary care providers/practices could achieve it. Five participants strongly favored providing PrEP in HIV care practices. CONCLUSION Although there may be multiple "homes" for PrEP, implementation research is needed to identify the most effective delivery approaches.