Photo Credit: Claudenakagawa

Clinician-reported barriers to PrEP prescribing include finances, perceptions about HIV risk, lack of training, and the amount of time required for PrEP care.

“Promoting biomedical HIV prevention strategies necessitates the active engagement of healthcare providers to expand the use of PrEP among HIV-vulnerable populations,” Yordanos Tiruneh, PhD, MPhil, and colleagues wrote. “Recent data, however, suggest that physicians face obstacles when offering HIV prevention strategies. Many healthcare workers remain unfamiliar with PrEP guidelines, lacking the knowledge and training needed to prescribe these interventions.”

While Dr. Tiruneh and colleagues noted that awareness and knowledge of PrEP have increased since the publication of CDC guidelines, they referenced regional disparities and the need for targeted, clinician-centered interventions in specific geographic locations to improve practices around discussing and prescribing PrEP.

For a study published in Healthcare, the researchers conducted a 25-question survey of clinicians in Texas that assessed demographics, clinical experience, medical setting, awareness of PrEP guidelines, knowledge about PrEP, prescribing practices, and barriers to prescribing the medication. Dr. Tiruneh and colleagues used multiple regression analysis to identify factors related to PrEP prescribing behaviors.

Half of Respondents Report Barriers to PrEP Prescribing

The analysis included survey responses from 519 clinicians (median age, 47; 50.9% women; 61.6% White). Respondents had an average of 17 years of experience and collectively cared for patients across 62 counties.

Most clinicians (74.6%) were familiar with CDC and/or United States Preventive Services Taskforce (USPSTF) recommendations and guidance on prescribing PrEP to those at risk for HIV, including partners of patients with HIV. Of these respondents, 34.2% were actively prescribing PrEP to patients. Nearly half of clinicians (49.3%) noted they were likely to prescribe PrEP to those who could benefit from it.

However, more than half of the survey respondents reported barriers to prescribing PrEP, including 25.4% who described minor barriers and 26% who described a moderate or major barrier. These results reflect a lack of familiarity with CDC and USPSTF guidelines for prescribing PrEP, according to Dr. Tiruneh and colleagues.

Study results also showed that clinicians who reported familiarity with CDC and/or USPSTF recommendations and guidelines were 18 times more likely to prescribe PrEP (adjusted OR, 18.0; P<0.001).

Addressing Clinician-Reported Barriers to PrEP Prescribing

Dr. Tiruneh and colleagues outlined the major and moderate barriers clinicians identified and potential solutions for many of these concerns. Minor barriers to prescribing PrEP were largely similar, with clinicians citing a lack of familiarity with CDC/USPSTF guidelines (25.4%), lack of training (25.1%), and time required to counsel and monitor patients on PrEP (25.9%) as minor barriers.

Moderate & Major Barriers to Prescribing PrEP

• • Concerns about finances (48.0%)
  • Concerns about the time needed to counsel and monitor patients on PrEP (40.8%)
  • Lack of training for prescribing and managing PrEP (40.4%)
  • Perceptions that patients may not be interested in PrEP (18.8%)
  • Patient population might not be vulnerable to HIV (14.2%)

Potential Solutions

• • Lack of Training: Expanded training programs, whether as part of medical training or as continuing medical education
  • Concerns about Finances: Making use of Affordable Care Act rules requiring most private insurance plans and Medicaid expansion programs to cover PrEP
  • Concerns about Finances: State-level PrEP assistance programs and the federal Ready, Set, PrEP Program
  • Counseling & Monitoring Patients on PrEP: Streamline follow-up processes by restricting some visits to laboratory testing only
  • Counseling & Monitoring Patients on PrEP: Involve ancillary staff in adherence counseling and risk reduction education with patients who need more time with clinicians identified through targeted screening

Implementing Strategies to Improve HIV Prevention

Dr. Tiruneh and colleagues emphasized that policies should incorporate specific guidelines into clinical practice and quality improvement programs. They also noted that identifying and addressing the diverse needs of different clinician communities and demographics is necessary for implementing effective public health interventions.

“Targeted educational interventions, needs assessments, interactive teaching, and supplementary online resources, along with practical documentation tools, have proven successful in strengthening [clinician] capabilities to adopt evidence-based practices,” the researchers wrote. “By adopting these measures, healthcare systems can enhance the uptake and effectiveness of PrEP, ultimately improving HIV prevention outcomes and advancing the goal of ending the HIV epidemic.”