Pre-Exposure Prophylaxis (PrEP) for Some?: HIV Care Providers' Likelihood to Prescribe PrEP for HIV Prevention Differs By Patient Type

Introduction: Pre-exposure prophylaxis (PrEP), the antiretroviral treatment regimen for HIV-negative people at high risk of acquiring HIV, has demonstrated efficacy across clinical trials in several patient populations. However, in the U.S., much attention on PrEP has focused on men who have sex with men (MSM). In 2014, the Centers for Disease Control (CDC) released detailed guidelines to aid providers in prescribing PrEP for their high-risk patients, and extended these guidelines to include not only MSM patients, but also heterosexuals at high-risk for HIV and injection drug users. To date, little is known about HIV care providers' views on prescribing PrEP to different patient populations.

Methods: The American Academy of HIV Medicine (AAHIVM), a professional association consisting of predominately front-line HIV care providers in the United States, was surveyed online in June 2014 to assess HIV care providers’ attitudes about PrEP, along with their willingness to prescribe PrEP to patients from various risk populations (e.g., MSM, heterosexuals, injection drug users).

Results: HIV care providers (n=363) reported being most likely to prescribe PrEP to MSM in a serodiscordant couple (78%). Providers' likelihood to prescribe PrEP was lower for other MSM patients (e.g., inconsistent condom use, history of sexuall transmitted infection), ranging from 58% to 64% reporting being "very likely" to prescribe the regimen. Of all patient groups assessed, HIV care providers reported a significantly lower likelihood of prescribing PrEP to heterosexuals at high risk of HIV (47%) and injection drug users (45%). Few provider demographic factors or general attitudes about PrEP were associated with likelihood to prescribe PrEP to these patient groups. Providers' practice-related behaviors (e.g., asking about condom use) were modestly and inconsistently associated with increased odds of willingness to prescribe PrEP to heterosexuals and injection drug users.

Conclusions: Findings suggest that despite recommendations from the CDC, providers’ willingness to prescribe PrEP varies by patient group. Further research to assess barriers to providers' full endorsement of PrEP for different patient groups, along with the implementation of interventions to address these barriers is warranted in order to enhance HIV prevention.