An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S.

Abstract

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but many primary care physicians (PCPs) have not incorporated PrEP into practice. While PrEP may be a key strategy to reducing high HIV transmission rates in the southern US, knowledge about PrEP prescribing patterns among PCPs in this region is lacking. An online survey was sent to a large network of PCPs at an academic medical center in North Carolina in October 2015. The survey was repeated in September 2016, after an educational intervention that included on-site trainings at 14 PCP offices. Chi-square tests were used to compare PrEP prescribing patterns among providers. The initial survey was sent to 389 PCPs, with 115 (30%) responding. Of these, 78% reported seeing men who have sex with men (MSM). Only 17% had prescribed PrEP. The most frequently identified barrier was lack of knowledge (60%). When the survey was repeated after the educational initiative, 79 PCPs (20%) responded. Of these, 90% reported seeing MSM, and 35% had prescribed PrEP. PCPs who had attended a training were more likely to have prescribed PrEP (OR 4.84, CI 1.77-13.21). In conclusion, PrEP prescribing among PCPs in the southern US is low. A survey among PCPs identified lack of knowledge as a barrier to prescribing, motivating an institutional-wide educational campaign in response. Further efforts are needed to continue to raise awareness and educate PCPs in the South about PrEP.

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

“…Of the 28 articles included in our systematic review, 18 studies reported lack of provider knowledge as a barrier to PrEP prescription. 24,[26][27][28]31,32,34,38,[40][41][42][43][44][45][46][47]49 PrEP awareness among PCPs increased steadily, from 24% to 66% between 2009 and 2015. 44 However, PrEP knowledge remained low, with only 17% of providers indicating that they had read the CDC guidelines in 2014.…”

“…49 Similarly among both PCPs in North Carolina and family planning providers throughout the United States, the most frequently reported barrier to prescribing PrEP was a lack of knowledge. 32,43 Seventy-five percent of the family planning providers and 42% of the PCPs reported they were uncomfortable prescribing PrEP due to a lack of knowledge. Notably, a majority of both PCPs and family planning providers stated that they would be willing to provide PrEP with more training.…”

“…Notably, a majority of both PCPs and family planning providers stated that they would be willing to provide PrEP with more training. 32,43 In general, HIV specialists were more knowledgeable about PrEP and the CDC guidelines pertaining to its use. A study done with PCPs noted that although 75% of participants were aware that PrEP existed, only 37% stated that they were somewhat or very familiar with the guidelines for prescription, and only 17% had prescribed it.…”

“…49 Similarly, two other studies reported that providers who did not prescribe PrEP due to cost/insurance issues were unaware of insurance coverage options. 32,42 An extension of this barrier was reported by providers with PrEP prescribing experience, where providers reported a significant amount of time spent on the phone with insurance companies and paperwork required to establish coverage. 29 In contrast, only 12% of HIV specialists nationwide reported cost as an issue in another study.…”

“…In nine reviewed studies, providers reported worries about adherence to the drug regimen and the strict follow-up requirements for daily PrEP usage. 27,28,31,32,[34][35][36]39,49 According to the CDC guidelines, patients on PrEP should follow up every 3 months to undergo HIV/STI testing, with tests for renal functioning twice yearly. 17 This level of care can present a burden to providers and their clinics, as they may not have the staff or time necessary to assess each patient.…”