Background: The U.S. Public Health Service recently issued guidelines about daily use of medication as pre-exposure prophylaxis (PrEP) to prevent HIV infection, and recommended that physicians, including primary care physicians (PCPs), offer PrEP to high-risk patients. Although there has been an increase in PrEP uptake, the CDC cites that 34% of PCPs have never heard of PrEP. We assessed the knowledge, attitudes and beliefs regarding PrEP in a large network of primary care clinics in the Southeast, which continues to have the highest rates of HIV in the U.S.
Methods: An online survey using Qualtrics software was emailed to PCPs in the Duke University Primary Care Network, Duke Private Diagnostic Center, and Duke Internal Medicine Program located in Durham, North Carolina. The survey consisted of 12 multiple choice questions aimed at understanding sentiments towards PrEP and potential barriers to its implementation in primary care clinics. No incentive was provided.
Results: Of 389 PCPs surveyed, 115 (30%) responded representing 24 clinical sites: 44% were faculty physicians, 42% resident physicians, 7% physician assistants, and 6% nurse practitioners. 78% reported seeing patients who are men who have sex with men (MSM); 12% said they did not see MSM, and 10% were not sure. Only 17% had prescribed PrEP. In response to why providers had not prescribed PrEP, 60% cited lack of knowledge, 56% said they had no candidates, and 42% mentioned lack of comfort in prescribing PrEP. Providers said that they would be more likely to prescribe PrEP if they had additional training (74%), reference materials (56%) and an infectious disease consultation by phone or pager (26%).
Conclusions: PrEP is a medication that has been shown to successfully prevent HIV in high-risk populations, but is not currently being prescribed by clinicians associated with a large academic US hospital in a regional epicenter for HIV. Although the majority of PCPs state that they see MSM in their practice, most respondents still did not prescribe PrEP. Our results indicate that lack of knowledge is the primary reason for not prescribing PrEP, but providers were open to additional education and reference materials.

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