Advancing the case for nurse practitioner-based models to accelerate scale-up of HIV pre-exposure prophylaxis

J Clin Nurs. 2019 Jan;28(1-2):351-361. doi: 10.1111/jocn.14675. Epub 2018 Oct 11.

Abstract

Aims: To explore the factors that position nurse practitioners (NPs) to lead the implementation of HIV pre-exposure prophylaxis.

Background: The HIV epidemic represents a global health crisis. Reducing new HIV infections is a public health priority, especially for Black and Latino men who have sex with men (MSM). When taken as directed, co-formulated emtricitabine and tenofovir have over 95% efficacy in preventing HIV; however, substantial gaps remain between those who would benefit from pre-exposure prophylaxis (PrEP) and current PrEP prescribing practices.

Design: This is a position paper that draws on concurrent assessments of research literature and advanced practice nursing frameworks.

Method: The arguments in this paper are grounded in the current literature on HIV PrEP implementation and evidence of the added value of nurse-based models in promoting health outcomes. The American Association of Colleges of Nursing's advanced nursing practice competencies were also included as a source of data for identifying and cross-referencing NP assets that align with HIV PrEP care continuum outcomes.

Conclusions: There are four main evidence-based arguments that can be used to advance policy-level and practice-level changes that harness the assets of nurse practitioners in accelerating the scale-up of HIV PrEP.

Relevance to clinical practice: Global public health goals for HIV prevention cannot be achieved without the broader adoption of PrEP as a prevention practice among healthcare providers. NPs are the best hope for closing this gap in access for the populations that are most vulnerable to HIV infection.

Keywords: HIV pre-exposure prophylaxis; HIV prevention; nurse practitioners; prescribing practices.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Black or African American
  • HIV Infections / prevention & control*
  • Hispanic or Latino
  • Humans
  • Male
  • Nurse Practitioners / organization & administration*
  • Practice Patterns, Nurses'
  • Pre-Exposure Prophylaxis*
  • Sexual and Gender Minorities*

Substances

  • Anti-HIV Agents