Study: Just 54% of Practitioners Have Prescribed PrEP to HIV-Vulnerable Patients

A new study suggests that many medical professionals are not prescribing HIV prevention medications, even to patients at risk of contracting HIV.

Researchers at Vanderbilt University Medical Center surveyed 519 practitioners in 5 major cities who attended a continuing education course on HIV between March and May 2015. According to the study, published in PLOS ONE, less than 10% of the more than 1 million people vulnerable to HIV are taking pre-exposure prophylaxis (PrEP).¹

“With a US policy goal to eradicate HIV by 2030, practitioners are central to ensuring the delivery of PrEP across care settings,” said study author Ashley Leech, PhD, in a statement.¹

Of the respondents, 70% were physicians, 9% were physician assistants, and 21% were nurse practitioners. The average age was 49 years old, with the majority identifying as female (57%) and white (58%).² The majority of respondents said they had practiced independently for more than 10 years. Finally, 38% specialized in infectious disease, 27% in family medicine, 26% in internal medicine, and 9% in other specialties.²

The survey found that internal medicine prescribers were 1.6 times more likely than infectious disease practitioners to prescribe PrEP, which the authors said was an indicator of the importance of internal and family medicine practitioners. These providers can play a major role in assessing and mitigating their patients’ risk of contracting HIV.¹

Leech noted that a possible explanation may be the longstanding confusion or disagreements between HIV experts and primary care practitioners over who should be responsible for prescribing PrEP. Age, years of training, and sex of the survey respondents were also significantly associated with prescribing experience.¹

The researchers also found that contrary to earlier beliefs, practitioners might be more willing to prescribe PrEP as a first clinical step for patients who inject drugs. However, they noted that more work is needed to effectively communicate with HIV-vulnerable groups and to reach individuals who could most benefit from PrEP.¹

“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,” Leech concluded.¹

REFERENCE

• Many practitioners are not prescribing HIV prevention medication, study finds [news release]. Vanderbilt University Medical Center; September 3, 2020. https://www.vumc.org/health-policy/HIV-preventive-medication-prescription-doctors. Accessed September 24, 2020.
• Leech AA, Christiansen CL, Linas BP, Jacobsen DM, et al. Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US. PLOS ONE; September 3, 2020. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238375. Accessed September 24, 2020.