P-12 Primary care physicians’ perceptions of pre-exposure prophylaxis (PrEP) for HIV in Guyana: a qualitative study

Methods: The qualitative, phenomenological approach couched in the interpretivist paradigm was used. Ethical approval and informed consent were obtained. Purposive sampling was used to achieve a heterogeneous group of physicians from publicly funded clinics in Region 4. In-person interviews lasting 25–45 minutes were conducted using a piloted, semi-structured guide. These interviews were audio recorded and transcribed verbatim, and themes were devel- oped following a hybrid of inductive and deductive coding. Saturation occurred at the 13th participant. 

Results: Eleven females and two males representing vary- ing years of experience and specialization participated. The four  themes  developed were:  1) physicians’  experiences; 2) physicians’ clinical competence; 3) opinions of and con- cerns about PrEP; 4) perceived facilitators of and barriers to prescription. All the participants knew what PrEP was used for and viewed it as a necessary intervention. Concerns about the safety of the drug, patients’ adherence, drug resist- ance, increased incidence of sexually transmitted infections, and diversion of the drug from the HIV program to facilitate PrEP prescription were expressed. Continuous medical edu- cation was perceived as a facilitator while unavailability of the drug and limited support staff were identified as potential barriers. 

Conclusion: Primary care physicians knew what PrEP  was used for, were able to identify who should use it, and believed it was necessary to reduce HIV incidence. Targeted educational programs should be developed to improve their clinical competence, increase confidence in the safety of the drug, address their concerns so they can confidently prescribe PrEP.