Academic Detailing to Increase Prescribing of HIV Pre-exposure Prophylaxis.

Although HIV pre-exposure prophylaxis can decrease new cases of HIV by up to 99%, many patients who could benefit from pre-exposure prophylaxis never receive prescriptions for it. Because pre-exposure prophylaxis is indicated for patients who do not have an infectious disease, increasing pre-exposure prophylaxis prescribing by primary care and generalist clinicians represents a key element of the Ending the HIV Epidemic in the U.S. initiative. This review provides an overview of academic detailing and how it is currently being used to increase pre-exposure prophylaxis prescribing. Academic detailing is outreach education that engages with clinicians in 1-to-1 or small group interactions focused on identifying and addressing an individual clinician's needs to increase their use of evidence-based practices. Academic detailing has been proven in multiple previous research studies, and the principles required for successful implementation include interactivity, clinical relevance of content, and focus on defined behavior change objectives. Clinician barriers to pre-exposure prophylaxis prescribing may occur in the domains of knowledge, attitudes, or behavior, and academic detailing has the potential to address all of these areas. State and local health departments have developed academic detailing programs focused on pre-exposure prophylaxis prescribing and other elements of HIV prevention-sometimes describing the approach as public health detailing. Few studies of academic detailing for pre-exposure prophylaxis have been published to date; rigorous evaluation of HIV-specific adaptations and innovations of the approach would represent an important contribution. In the setting of the COVID-19 pandemic, interest in virtual delivery of academic detailing has grown, which could inform efforts to implement academic detailing in rural communities and other underserved areas. Increasing this capacity could make an important contribution to Ending the HIV Epidemic in the U.S. and other HIV prevention efforts.

A Systematic Review of the Social Network Strategy to Optimize HIV Testing in Key Populations to End the Epidemic in the United States.

The United States (U.S.) has a plan to end the HIV epidemic by 2030. The plan's first pillar prioritizes HIV testing. Social Network Strategy (SNS) is an intervention to reach persons not routinely testing for HIV. We conducted a systematic review of SNS to understand its implementation to optimize HIV testing in the U.S. among key populations. The eligibility criteria included peer-reviewed papers based in the U.S. and focused on HIV testing. We identified and thematically analyzed 14 articles to explore factors associated with successful implementation. Key themes included: (1) social network and recruiter characteristics; (2) strategies for and effectiveness of recruiting key populations; (3) use of and types of incentives; (4) trust, confidentiality, and stigma concerns; and (5) implementation plans and real-world guidance. Cohort studies indicated that SNS detects more incident HIV cases. Partnerships with health departments are critical to confirm new diagnoses, as are developing plans that support recruiters and staff. SNS is a promising strategy to optimize HIV testing among key populations.