Abstract
HIV pre-exposure prophylaxis (PrEP) was FDA approved in 2012, but uptake remains low. To characterize what would facilitate health care providers’ increased PrEP prescribing, we conducted a 10-city, online survey of 525 primary care providers (PCPs) and HIV providers (HIVPs) to assess awareness, knowledge, and experience with prescribing PrEP; and, comfort with and barriers to PrEP-related activities. Fewer PCPs than HIVPs had heard of PrEP (76 vs 98%), felt familiar with prescribing PrEP (28 vs. 76%), or had prescribed it (17 vs. 64%). PCPs were less comfortable than HIVPs with PrEP-related activities such as discussing sexual activities (75 vs. 94%), testing for acute HIV (83 vs. 98%), or delivering a new HIV diagnosis (80 vs. 95%). PCPs most frequently identified limited knowledge about PrEP and concerns about insurance coverage as prescribing barriers. PCPs and HIVPs differ in needs that will facilitate their PrEP prescribing. Efforts to increase PrEP uptake will require interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP.
Resumen
Profilaxis pre-exposición por VIH (PrEP) fue aprobado por la FDA en 2012, pero su utilización ha sido lento. Para caracterizar lo que facilataría un aumento de la prescripción de profilaxis pre-exposición entre los proveedores de salud, se realizó una encuesta en línea con 525 proveedores de atención primaria (PAP) y los proveedores de VIH (PVIH) en diez ciudades, para evaluar la conciencia, conocimiento y la experiencia con la prescripción de profilaxis pre-exposición; y comodidad con y barreras a las actividades relacionadas con la prescripción de PrEP. Menos PAPs que PVIHs habían oído hablar de profilaxis pre-exposición (76 vs 98%), se sentía familiarizado con prescripción de profilaxis pre-exposición (28 vs. 76%), o habían prescrito (17 vs. 64%). Los PAPs eran menos cómodo que PVIHs con actividades relacionadas con la PrEP como hablar sobre las actividades sexuales (75 vs. 94%), las pruebas de VIH aguda (83 vs. 98%), o la entrega de un nuevo diagnóstico de VIH (80 vs. 95%). Los PAPs frecuentemente identificaron un conocimiento limitado sobre PrEP y preocupaciones acerca de la cobertura de seguro como barreras de prescripción. PAPs y PVIHs difieren en las necesidades que van a facilitar su prescripción de PrEP. Los esfuerzos para aumentar la absorción de la PrEP requerirán intervenciones para aumentar el conocimiento, la comodidad, y las habilidades de los proveedores para prescribir PrEP.
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Funding
This work was supported by Gilead Sciences, Inc. and the National Institute of Mental Health at the National Institutes of Health [Grant Numbers 5P30MH052776, K01-MH099956].
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A.P. receives research support from Gilead Sciences, Inc. J.W., J.O., T.M., L.B., and J.K. report no conflict of interest.
Research Involving Human Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This study was reviewed by the Institutional Review Board of the Medical College of Wisconsin. It met the Board’s definition of “minimal risk” and a waiver of informed consent was granted.
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Petroll, A.E., Walsh, J.L., Owczarzak, J.L. et al. PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists. AIDS Behav 21, 1256–1267 (2017). https://doi.org/10.1007/s10461-016-1625-1
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DOI: https://doi.org/10.1007/s10461-016-1625-1