Primary Care Provider Attitudes Toward HIV PrEP

Novel prevention methods can help reduce the 45,000 new cases of HIV that occur in the United States annually.

Men who have sex with men (MSM), especially young and black MSM, are increasingly infected with HIV despite the prevailing downward trend in other groups.

Public health experts are increasingly promoting pre-exposure prophylaxis (PrEP) to stymie infection in high-risk individuals. PrEP clinical trials have examined tenofovir disoproxil fumarate alone or in combination with emtricitabine among MSM, injection drug users, and heterosexually active men and women.

The journal PLOS One recently published study results that show primary care providers have been mostly unaware of PrEP, but they’re willing to prescribe it once they’re educated on PrEP delivery.

The study authors surveyed approximately 1500 physicians and nurse practitioners from 2009 through 2015 (except 2011) to assess their awareness of PrEP, willingness to prescribe, and whether they support the use of public funds to pay for PrEP. The researchers also surveyed 251 pharmacists in 2012.

Less than 1% of respondents prescribed antiretroviral therapy in 2009, 2010, and 2012. PrEP prescribing increased to 4% in the next 2 years, and then 7% in 2015. Almost 75% of participants had prescribed PrEP therapy to MSM, while 23% had prescribed it to injection drug users.

One in 4 prescribers had prescribed PrEP to uninfected patients in HIV-discordant couples seeking conception, 45% to uninfected women, and 30% to uninfected men in an HIV-discordant couple not planning to conceive.

PrEP awareness almost tripled between 2009 and 2015 (24% to 66%). Clinicians reported near-universal willingness to prescribe PrEP (91%) and overwhelming support for PrEP to partners of HIV-positive individuals (79%), MSM (66%), and injection drug users (63%).

The majority of surveyed clinicians (58%) supported the use of public funds to provide PrEP to uninsured patients.

Surveyed pharmacists provided some information indicative of their practices. The majority (66%) were engaged in medication therapy management, almost half had established collaborative practice agreements, and 57% said they would provide onsite HIV testing if asked.

These study results shed light on primary care providers’ increasing awareness and willingness to prescribe PrEP. More PrEP use may invigorate the downward trend in HIV diagnoses.