Need for Primary Care Physician Education Around HIV Preexposure Prophylaxis (PrEP)

In 2012, the Food and Drug Administration approved emtricitabine/tenofovir (Truvada) for HIV preexposure prophylaxis (PrEP) as an effective way to prevent transmission of the virus that causes AIDS. The CDC estimates that 1.2 million people in the United States are at substantial risk for contracting HIV and thus currently eligible for PrEP.1 These groups include: men who have sex with men (MSM), persons who inject drugs, and high-risk heterosexual adults (e.g., commercial sex workers, individuals in HIV sero-discordant relationships). PrEP has been shown to decrease the risk of acquiring HIV by more than 90% in MSM and high-risk heterosexual adults and more than 70% in people who inject drugs.2,3,4 Over a nearly three-year period in a large San Francisco clinic, no persons receiving PrEP contracted HIV.5 Furthermore, the AMA publically supports the use of PrEP for HIV prevention and physician education on the subject.6 Despite these facts, there has been both a national and local underutilization of this effective method of HIV prevention.

Multiple studies investigating PrEP prescribing practices have shown a correlation between education about PrEP and a physician’s intent to prescribe.7,8 Physicians who considered PrEP less effective reported limited knowledge and experience with PrEP8; up to 34% of physicians have not heard of PrEP.9 Despite nearly 75% of physicians in New England reporting having heard of PrEP, only 19% have prescribed PrEP. When asked, these physicians most often cited a need for more knowledge around PrEP before prescribing.10

Thus, there is a clear need for physician education on PrEP for patients at risk for contracting HIV. Given this significant need and the inherent preventative nature of PrEP, education should be directed towards primary care physicians.

- David M. Balyozian and Carl G Streed, Jr., M.D.

For more information, visit these useful websites:

Fast Facts on PrEP: www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf
CDC PrEP Page: www.cdc.gov/hiv/risk/prep/
CDC Vital Signs Link: www.cdc.gov/vitalsigns/hivprep/


1 Smith, D. L., et al. Vital Signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition — United States, 2015. Morbidity and Mortality Weekly Report. (2015) (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6446a4.htm?s_cid=mm6446a4_w)
2 Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012;367:399–410
3 Choopanya K, Martin M, Suntharasamai P, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2013;381:2083–90
4 Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010;363:2587–99.
5 Volk J. E., et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clin Infect Dis. (2015) doi: 10.1093/cid/civ778
6 AMA urges more physician education on use of once-a-day HIV prevention. (2016)
 http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-physician-education-hiv-prep.page
7 Blumenthal, J., et al. (2015). Knowledge is power! Increased provider knowledge scores regarding pre- exposure prophylaxis (PrEP) are associated with higher rates of PrEP prescription and future intent to prescribe PrEP." AIDS Behav 19(5): 802-810.
8 Castel, A. D., et al. (2015). Understanding HIV Care Provider Attitudes Regarding Intentions to Prescribe PrEP. J Acquir Immune Defic Syndr 70(5): 520-528.
9 DocStyles, unpublished data, 2015
10
Krakower, D. S., et al. (2015). Knowledge, beliefs and practices regarding antiretroviral medications for HIV prevention: Results from a survey of healthcare providers in New England. PLoS One 10(7): e0132398.

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