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Factors Related to Pre-exposure Prophylaxis Prescription by U.S. Primary Care Physicians.

ABSTRACT: INTRODUCTION:Although pre-exposure prophylaxis (PrEP) greatly reduces risk of HIV infection in HIV-negative individuals, use is not widespread enough to impact HIV incidence. Involvement of primary care physicians (PCPs) in PrEP prescription is essential, but previous research has shown low rates of prescription among PCPs. To identify targets for interventions, the information-motivation-behavioral skills model for PrEP discussion and prescription was tested in a ten-city sample of PCPs. METHODS:PCPs from ZIP codes with high HIV incidence in ten U.S. cities (N=280, 52% male, 56% white) completed a survey online between July 2014 and May 2015. Information items assessed knowledge, motivation items evaluated attitudes, and behavioral skills items measured comfort with behaviors involved in prescribing PrEP. Providers indicated whether they had discussed PrEP with or prescribed PrEP to patients. Data were analyzed in 2015 and 2016. RESULTS:One third of PCPs had discussed and 17% had prescribed PrEP. A structural equation model with good fit supported the information-motivation-behavioral skills model. Information and motivation predicted behavioral skills (b=0.35, 95% CI=0.13, 0.57; and b=0.31, 95% CI=0.14, 0.47, respectively). Behavioral skills predicted prescription (b=0.27, 95% CI=0.12, 0.42). Furthermore, behavioral skills mediated effects of information and motivation on prescription (b=0.10, 95% CI=0.03, 0.19; and b=0.08, 95% CI=0.03, 0.16, respectively). CONCLUSIONS:The information-motivation-behavioral skills model can be applied to PCPs' PrEP discussion and prescription. Its constructs represent potential targets for PCP-directed interventions to increase PrEP use in high-risk populations.

SUBMITTER: Walsh JL

PROVIDER: S-EPMC5438776 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Factors Related to Pre-exposure Prophylaxis Prescription by U.S. Primary Care Physicians.

Walsh Jennifer L JL Petroll Andrew E AE

American journal of preventive medicine 20170328 6

<h4>Introduction</h4>Although pre-exposure prophylaxis (PrEP) greatly reduces risk of HIV infection in HIV-negative individuals, use is not widespread enough to impact HIV incidence. Involvement of primary care physicians (PCPs) in PrEP prescription is essential, but previous research has shown low rates of prescription among PCPs. To identify targets for interventions, the information-motivation-behavioral skills model for PrEP discussion and prescription was tested in a ten-city sample of PCPs ...[more]

PMID: 28363410

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Project description:BackgroundAmong health care providers, prescription of HIV pre-exposure prophylaxis (PrEP) has been low. Little is known specifically about primary care physicians (PCPs) with regard to PrEP awareness and adoption (i.e., prescription or referral), and factors associated with adoption.ObjectiveTo assess PrEP awareness, PrEP adoption, and factors associated with adoption among PCPs.DesignCross-sectional online survey conducted in April and May 2015.RespondentsMembers of a national professional organization for academic primary care physicians (n?=?266).Main measuresPrEP awareness, PrEP adoption (ever prescribed or referred a patient for PrEP [yes/no]), provider and practice characteristics, and self-rated knowledge, attitudes, and beliefs associated with adoption.Key resultsThe survey response rate was 8.6 % (266/2093). Ninety-three percent of respondents reported prior awareness of PrEP. Of these, 34.9 % reported PrEP adoption. In multivariable analysis of provider and practice characteristics, compared with non-adopters, adopters were more likely to provide care to more than 50 HIV-positive patients (vs. 0, aOR?=?6.82, 95 % CI 2.06-22.52). Compared with non-adopters, adopters were also more likely to report excellent, very good, or good self-rated PrEP knowledge (15.1 %, 33.7 %, 30.2 % vs. 2.5 %, 18.1 %, 23.8 %, respectively; p?<?0.001) and to perceive PrEP as extremely safe (35.1 % vs. 10.7 %; p?=?0.002). Compared with non-adopters, adopters were less likely to perceive PrEP as being moderately likely to increase risk behaviors ("risk compensation") (12.8 % vs. 28.8 %, p?=?0.02).ConclusionsWhile most respondents were aware of PrEP, only one-third of PrEP-aware PCPs reported adoption. Adopters were more likely to have experience providing HIV care and to perceive PrEP as extremely safe, and were less likely to perceive PrEP use as leading to risk compensation. To enhance PCP adoption of PrEP, educational efforts targeting PCPs without HIV care experience should be considered, as well as training those with HIV care experience to be PrEP "clinical champions". Concerns about safety and risk compensation must also be addressed.

Dataset Information

Factors Related to Pre-exposure Prophylaxis Prescription by U.S. Primary Care Physicians.

Publications

Factors Related to Pre-exposure Prophylaxis Prescription by U.S. Primary Care Physicians.

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