Nashville, TN—
Pre-exposure prophylaxis for those who are vulnerable to HIV infection remains under-prescribed, according to new survey.

With results published in PLOS ONE, a recent survey found that only about 54% of medical practitioners surveyed say they have prescribed pre-exposure prophylaxis (PrEP) to HIV-vulnerable patients.

Vanderbilt University Medical Center investigators surveyed 519 practitioners in five major U.S. cities who attended a continuing medical education course on HIV between March and May 2015. 

The authors say they were prompted to conduct the survey because PrEP, which is a once-daily medication that is a widely accepted method of preventing HIV transmission, is prescribed to less than 10% of the more than 1 million people vulnerable to HIV.

“With a U.S. policy goal to eradicate HIV by 2030, practitioners are central to ensuring the delivery of PrEP across care settings,” explained Ashley Leech, PhD, assistant professor of Health Policy at Vanderbilt. “Our findings, however, indicate that even among a subset of HIV-focused practitioners, PrEP prescribing is not routine.”

Interestingly, the study found that internal-medicine prescribers were 1.6 times more likely to prescribe PrEP than infectious-disease practitioners. Researchers note that is an indicator of how important internal and family medicine practitioners are in assessing and mitigating risk in their patients.

Dr. Leech suggested that longstanding confusion or disagreement between HIV and primary care practitioners over who should be responsible for prescribing this preventive medication could underlie the slow adoption of PrEP among practitioners. The survey found that age, years of training, and sex of the independent prescribers were also significantly associated with prescribing experience.

“While a number of factors could impact PrEP prescribing, including patients’ low familiarity with the drug or practitioners’ lack of opportunity in offering PrEP, in order for the drug to be effective at eliminating HIV in the United States in the next 10 years, the proportion of prescribing needs to increase, with more effort placed on identifying risk across populations and clinical specialties,” Dr. Leech said.

Between March and May 2015, researchers provided a paper survey to 954 participants at continuing medical education advanced-level HIV courses in five locations across the U.S. on practitioner practices and preferences of PrEP. Researchers write that 652 of the participants met their inclusion criteria of being independent prescribers, and 519 of those (80%) responded to the survey.

Despite being a highly motivated group of practitioners, only slightly more than half reported ever prescribing PrEP, and internal-medicine practitioners were 1.6 times more likely than infectious-disease practitioners to have prescribed the prophylaxis (95% CI: 0.99-2.60, P = .0524).

“Based on clinical vignettes describing different hypothetical prescribing scenarios, practitioners who viewed PrEP as the first clinical step for persons who inject drugs (PWID) were twice as likely to have also considered PrEP as the first clinical option for safer conception, and vice-a-versa (95% CI, 1.4-3.2, P <.001,” the authors point out. “Practitioners considering PrEP as the first preventive option for [male-to-male sex] were nearly six times as likely to also consider PrEP as the first clinical step for [people who inject drugs], and vice-a-versa (95% CI, 2.28-13.56, P = .0002).”

Researchers conclude that PrEP prescribing isn’t routine even among a subset of HIV-focused clinicians, adding, “This group of practitioners could be an optimal group to engage individuals that could most benefit from PrEP.”

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