HIV providers’ likelihood to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention differs by patient type: a short report

ABSTRACT

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. The Centers for Disease Control (CDC) have released detailed guidelines to aid providers in prescribing PrEP for their high-risk patients, including men who have sex with men (MSM), high-risk heterosexuals, and injection drug users (IDUs). Given that much attention in PrEP has focused on MSM patients, the present study used an online survey to assess factors involved in HIV care providers’ (n = 363) decisions about prescribing PrEP, along with their willingness to prescribe PrEP to patients from various risk populations (e.g., MSM, heterosexuals, IDUs). The efficacy of PrEP was an important factor in providers' decisions about prescribing PrEP, as were considerations about patients’ adherence to the regimen, regular follow-up for care, and medication costs. This survey's findings also suggest that providers’ willingness to prescribe PrEP varies by patient group, with providers most willing to initiate the regimen with MSM who have an HIV-positive partner, and least willing to prescribe to high-risk heterosexuals or IDUs. In the context of the current CDC recommendations for PrEP that include MSM, heterosexuals, and IDUs, examining providers’ rationales for and barriers against supporting this HIV prevention strategy across patient groups merits further attention.

KEYWORDS:

• Pre-exposure prophylaxis (PrEP)
• HIV/AIDS
• HIV care providers
• prevention

Acknowledgements

We thank Bruce J. Packett II, Kathy Brown, MD, FACP, AAHIVS, and Sheryl L. Catz, Ph.D. for their contributions to this project. Survey development was supported by the American Academy of HIV Medicine (AAHIVM) and Gilead Sciences, Inc. The authors received no financial compensation from AAHIVM or Gilead Sciences, Inc. for their work on this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The contribution of Dr Adams was supported by Grant T32 AG027677 from the National Institute on Aging.