Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but many primary care physicians (PCPs) have not incorporated PrEP into practice. While PrEP may be a key strategy to reducing high HIV transmission rates in the southern US, knowledge about PrEP prescribing patterns among PCPs in this region is lacking. An online survey was sent to a large network of PCPs at an academic medical center in North Carolina in October 2015. The survey was repeated in September 2016, after an educational intervention that included on-site trainings at 14 PCP offices. Chi-square tests were used to compare PrEP prescribing patterns among providers. The initial survey was sent to 389 PCPs, with 115 (30%) responding. Of these, 78% reported seeing men who have sex with men (MSM). Only 17% had prescribed PrEP. The most frequently identified barrier was lack of knowledge (60%). When the survey was repeated after the educational initiative, 79 PCPs (20%) responded. Of these, 90% reported seeing MSM, and 35% had prescribed PrEP. PCPs who had attended a training were more likely to have prescribed PrEP (OR 4.84, CI 1.77-13.21). In conclusion, PrEP prescribing among PCPs in the southern US is low. A survey among PCPs identified lack of knowledge as a barrier to prescribing, motivating an institutional-wide educational campaign in response. Further efforts are needed to continue to raise awareness and educate PCPs in the South about PrEP.
D espite significant advances in human immunodeficiency virus (HIV) treatment, the burden of HIV in the United States remains persistently high, with approximately 40,000 newly diagnosed infections each year [1]. The number of annual HIV infections attributed to male-to-male sexual contact has increased over the past decade, particularly among racial/ethnic minority young men who have sex with men (MSM) [1, 2]. Young black MSM (YMSM) aged 13-24 years are now the most severely affected subgroup of MSM, with over 3,500 new HIV infections attributable to male-tomale sexual acquisition among black adolescents and young adults in 2015 [1]. Geographically, the South bears the highest HIV burden out of any US region, accounting for approximately half of all new infections in the United States in 2015 [1]. At the intersection of these attributes, young black MSM living in the southern United States represent a population that is especially vulnerable to HIV infection [1]. HIV pre-exposure prophylaxis (PrEP) is now established as a safe and efficacious strategy to reduce HIV transmission among high-risk individuals [3-7]. Following US Food and Drug Administration approval of daily oral emtricitabine/ tenofovir disoproxil fumarate for PrEP in 2012, the US Public Health Service released comprehensive clinical practice guidelines in May 2014 for use of PrEP, identifying MSM as a priority candidate population [8]. Actual utilization of PrEP, however, has remained limited [9, 10]. One study of MSM across 20 US cities found that only 4% were using PrEP in 2014 [11]. Moreover, disproportionately low rates of PrEP use among racial/ethnic minority MSM have been observed in multiple settings [9, 11-13]. Despite the substantial HIV burden in the southern United States, public awareness of PrEP in this region remains poorly characterized. In this study, we conducted a survey of individuals in Durham, North Carolina to evaluate awareness of PrEP. Methods Setting Durham County is an urban community located in central North Carolina and is part of the Durham-Chapel Hill, North Carolina Metropolitan Statistical Area. Of US states, North Carolina had the 8th highest number of new HIV diagnoses in 2015 [1]. The rate of new HIV diagnoses in Durham was 20.3 per 100,000 population in 2015, compared to statewide and national HIV diagnosis rates of 13.4 and 12.3 per 100,000 population, respectively [1, 14]. Of 100 North
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