Primary care provider prep prescribing practices : southern United States

Abstract

The Southern United States (U.S.) accounts for more than half of new HIV cases annually and African Americans make up the majority of new HIV diagnoses in this region. Pre-Exposure Prophylaxis (PrEP) is an effective biomedical HIV prevention strategy that is underutilized. Few studies have examined the PrEP prescribing practices of primary care providers (PCPs), particularly in the Southern U.S. This cross-sectional survey, driven by the Transtheoretical Model (TTM), examined the prescribing practices of Southern U.S. PCPs. Relationships between PCPs personal and practice variables were examined, together with TTM decisional balance variables. Participants (n=223) who had more African American patients in their practice were more likely to be in a higher TTM stage of change (p = .002) and were more likely to have written a PrEP prescription (p = .001). Access to PrEP resources (OR = 1.85, p = .001), streamlined insurance prior authorization processes (OR = 1.52, p = .010), working with staff who have PrEP knowledge (OR = 1.51, p = .033), having PrEP training (OR = 40.26, p < .001) and having patients who are motivated to take PrEP (OR = 2.19, p = .007) were significant facilitators to PrEP prescribing. Significant barriers to PrEP prescribing included a lack of provider PrEP training (OR = 0.43, p = .003), lack of clinical leadership regarding PrEP (OR = 0.65, p = .018), lack of insurance (OR = 2.74, p = .002), and likelihood of low patient adherence to PrEP (OR = 0.53, p = .001). Findings indicate that this sample of PCPs were more likely to be at a higher TTM stage of change and have written a PrEP prescription if they saw more African American patients in their practice. Further, significant facilitators of PrEP prescribing included access to PrEP resources, streamlined insurance prior authorization processes, working with staff who have PrEP knowledge, having PrEP training, and having patients who are motivated to take PrEP. Significant barriers to PrEP prescribing included a lack of PrEP training, a lack of clinical leadership regarding PrEP, patient lack of insurance, and likelihood of low patient adherence. This study contributes to the body of knowledge regarding PCP PrEP prescribing practices. Findings from this study may inform future interventions that aim to enhance PrEP prescribing among primary care providers who serve Southern African American individuals at risk for acquisition of HIV disease.