Study investigators found that health care professionals who were assigned male at birth and practiced in the Western region of the United States were more likely to prescribe PrEP to this high-risk population.
Despite pre-exposure prophylaxis (PrEP) expanding recommended ages for prevention of HIV in high-risk populations, adolescents and young adults have demonstrated a slower uptake of PrEP. Adolescents and young adults between ages 13 and 24 years are still largely not being prescribed PrEP, even though this high-risk group accounts for approximately 20% of new HIV infections.
A recent study published in Nature analyzes the characteristics of primary care physicians to see how demographic, clinical care, and implementation factors influence the prescribing of PrEP to adolescents and young adults. Although prior research has evaluated the prescribing patterns of PrEP in certain populations, the factors that influence prescribing are examined less frequently, according to the investigators.
The investigators used the Theoretical Domains Framework, a commonly used approach in research to evaluate physicians’ evidence-based practices. A prior study utilized this framework to determine physician intent to prescribe PrEP in adolescents.
The study authors determined that providers who were assigned male at birth, practiced in the Western region of the United States, and had more knowledge about PrEP prescribing guidelines were more likely to prescribe PrEP to adolescents and young adults. Further, differences in prescribing rates between genders could be due to male adolescents—who are more affected by HIV—seeking male providers, differences in adoption of new treatments by male and female providers, or proportion of male and female providers across different practices.
In addition, the research showed that geographic differences could be a result of the availability of providers who specialize in PrEP, or differences in state policies which allow minors to access HIV-related care without the permission of a parent or guardian. The authors note that additional research that explores these geographic differences could be beneficial in determining what influences the differences.
The findings could also indicate a potential value of programs that educate providers on PrEP and its prescribing guidelines. Further, geographic differences in prescribing behaviors suggest that changes to laws that allow adolescents to seek care related to HIV without parental consent could further improve the uptake of PrEP in this high-risk group.
“Most PrEP research focuses on providers’ intentions to prescribe, while we looked at the determinants of prior prescribing PrEP, finding 2 main points,” said study author Christopher Owens, PhD, assistant professor in the department of health behavior at the Texas A&M University School of Public Health, in a press release. “First, knowledge is important in better understanding providers’ behaviors in delivering this HIV preventive evidence-based practice. Also, structural factors like laws and access to care—that vary widely between states and regions—might be important in mediating or moderating providers’ prescription habits.”
Texas A&M University. What factors influence PrEP prescribing behavior in health care providers? News release. November 14, 2023. Accessed November 14, 2023. https://www.eurekalert.org/news-releases/1008027