PrEP Underutilized in HIV Prevention Efforts

Oral preexposure prophylaxis (PrEP) has the potential to prevent HIV transmission and ultimately to help eradicate this devastating viral infection. Currently, the FDA has approved 1 combination product, emitricibine/tenofovir disproxil fumarate, for preexposure prophylaxis. The CDC has included this antiviral combination and its clinical practice guidelines since 2014.

The Journal of the Association of Nurses in AIDS Care has published an article that describes primary care provider knowledge of and attitudes about PrEP. In it, they indicated that health care providers underutilize PrEP as an HIV preventive intervention.

This article was based on literature review. The researchers found that despite recommendations to employ PrEP since 2014, many health care providers said that they lack the knowledge and training to prescribe PrEP appropriately.

Infectious disease and HIV specialists appeared to be more willing to prescribe PrEP than primary care providers. One study found that health care practitioners often had insufficient knowledge about safety and drug resistance, and these knowledge gaps seem to be reasons not to prescribe PrEP.

Some providers indicated that they had concerns about risk compensation; meaning that they expected that patients treated with PrEP would be less likely to use condoms. Others cited logistic concerns including cost and insurance coverage, suggesting that patients would have trouble obtaining PrEP.

One study also indicated that health care practitioners who had favorable views about safety and risk were more likely to prescribe PrEP.

Many health care practitioners were unable to describe recommendations from the CDC clinical guidelines. Some providers said that cost was a barrier, but in 2017, FDA approved the first generic emitricibine/tenofovir disproxil fumarate. Experts anticipate that this approval will reduce the cost of treatment with PrEP.

The researchers concluded that an integral part of education for health care providers should focus on the importance of discussing risk reduction behaviors with patients before prescribing PrEP. They also recommended greater involvement of professional organizations to develop educational opportunities and promote the use of PrEP.

Reference

Turner L, Roepke A, Wardell E, Teitelman AM. Do you PrEP? A review of primary care provider knowledge of PrEP and attitudes on prescribing PrEP. J Assoc Nurses AIDS Care. 2018;29(1):83-92.