Study: Pre-Exposure Prophylaxis Significantly Under-Prescribed to Prevent HIV in Eligible Patients

Primary care is under-utilizing pre-exposure prophylaxis (PrEP) to reduce the spread of HIV, according to significant findings from a new study published in Sage. Only 0.9% of family medicine (FM) providers and 2.0% of general internal medicine (GIM) providers prescribed PrEP to eligible patients; however, the study authors do not fully know why prescribing rates continue to be low in the primary care setting.

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The authors highlighted that patients who are Black, of female gender, have an older age, or have a substance use disorder are less likely to receive PrEP from a GIM or FM. PrEP is a useful tool that helps to prevent against the transmission of HIV, with 2020 findings showing that 25% of people could benefit from PrEP use. HIV specialists have the know-how and experience to effectively prescribe PrEP; however, 75% of providers who prescribe PrEP work in FM and GIM, so they should understand how to identify eligible patients and utilize PrEP to its maximum capacity, according to the study authors.

Understanding both prescribing rates of FM and GIM practitioners and missed prescribing opportunities are important to inform educational and training interventions. As a result, investigators compared the frequency that FM and GIM—both forms of primary care— are prescribed PrEP to eligible patients.

Major findings from the study identified that Black patients received PrEP at a 46% lower rate than other races. In addition, patients with an anxiety disorder were 72% more likely to receive PrEP and were 67% more likely to start PrEP.

An age adjusted model showed that patients aged 18 to 29 years were more likely to receive PrEP than patients aged 40 to 49 years. Further, FM treated a higher percentage of patients aged 18 to 39 years (70%) than GIM (57%).

The findings show that PrEP is being administered by primary care providers to at-risk patients at a significantly low rate, although the US Preventive Services Task Force (USPSTF) recommends that clinicians offer PrEP to eligible people. Investigators propose increasing PrEP and training for FM and GIM providers, which can be given during residency or as continued education. More patients see an FM provider, and more patients under the care of an FM provider are PrEP-eligible (83%) compared to GIM (17%), therefore, education is particularly important.

It is worth noting that—despite less patients being cared for by a GIM provider—patients treated with GIM were still 2 times more likely to receive PrEP after index compared to those treated with FM (OR = 2.30; 95% CI:1.63-3.25). In general, eligible patients in GIM were 39% more likely to receive PrEP (OR = 1.39; 95% CI:1.29-1.50).

The study includes limitations, the first of which being that the majority female cohort does not reflect the patient population who is most at risk for HIV—men who have sex with men (MSM). Other limitations include missing data on sexual orientation, limited generalizability, the underestimation of the number of PrEP prescriptions, and bias from unmeasured confounding.

Reference

Drallmeier T, Salas J, Scherrer JF, et al. Differences Between General Internal Medicine and Family Medicine Physicians’ Initiation of Pre-Exposure Prophylaxis. Journal of Primary Care & Community Health. 2023;14. doi: 10.1177/21501319231201784