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Primary Care Physicians’ Willingness to Prescribe HIV Pre-exposure Prophylaxis for People who Inject Drugs

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Abstract

Pre-exposure prophylaxis for HIV (PrEP) is recommended for people who inject drugs (PWID). Despite their central role in disease prevention, willingness to prescribe PrEP to PWID among primary care physicians (PCPs) is largely understudied. We conducted an online survey (April–May 2015) of members of a society for academic general internists regarding PrEP. Among 250 respondents, 74% (n = 185) of PCPs reported high willingness to prescribe PrEP to PWID. PCPs were more likely to report high willingness to prescribe PrEP to all other HIV risk groups (p’s < 0.03 for all pair comparisons). Compared with PCPs delivering care to more HIV-infected clinic patients, PCPs delivering care to fewer HIV-infected patients were more likely to report low willingness to prescribe PrEP to PWID (Odds Ratio [95% CI] = 6.38 [1.48–27.47]). PCP and practice characteristics were not otherwise associated with low willingness to prescribe PrEP to PWID. Interventions to improve PCPs’ willingness to prescribe PrEP to PWID are needed.

Resumen

Se recomienda la profilaxis previa a la exposición al VIH (PrEP) para las personas que se inyectan drogas (PWID). A pesar de su papel central en la prevención de enfermedades, la voluntad de prescribir la PrEP a PWID entre los médicos de atención primaria (PCP) es en gran parte poco estudiada. Realizamos una encuesta en línea (abril–mayo de 2015) de miembros de una sociedad para internistas académicos generales con respecto a la PrEP. Entre los 250 encuestados, el 74% (n = 185) de PCP informó de una gran disposición a prescribir PrEP a PWID. Los PCP mostraron mayor probabilidad de prescribir PrEP a todos los demás grupos de riesgo de VIH (p < 0,03 para todas las comparaciones de parejas). En comparación con los PCP que prestaban atención a más pacientes con infección por el VIH, los PCP que proporcionaban atención a menos pacientes infectados con VIH tenían más probabilidades de notificar una baja predisposición a prescribir PrEP a PWID (Odds Ratio [IC 95%] = 6,38 [1,48–27,47]). PCP y las características de la práctica no se asociaron de otra manera con baja voluntad de prescribir PrEP a PWID. Se necesitan intervenciones para mejorar la disposición de los PCP a prescribir la PrEP a PWID.

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Acknowledgements

We would like to thank Ms. Katz for her assistance with programming the survey. A version of this work was presented as a poster presentation at the College on Problems of Drug Dependence Annual Meeting, June 16th, 2016 in Palm Springs, California.

Funding

This work was generously supported by Yale Center for Clinical Investigation (UL1 TR000142). EJ Edelman was supported as a Yale Drug Abuse, Addiction and HIV Research Scholars (DAHRS) Program during the writing of this manuscript (K12DA033312-03). BA Moore is supported by R01 DA034678. SK Calabrese is supported by K01-MH103080. O Blackstock is supported by K23MH102129-03.

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Authors and Affiliations

  1. Yale University School of Medicine, 367 Cedar Street, ESH A, suite 401, New Haven, CT, 06510, USA

    E. Jennifer Edelman, Brent A. Moore, Jeanette M. Tetrault & David A. Fiellin

  2. Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA

    E. Jennifer Edelman, Brent A. Moore, Sarah K. Calabrese & David A. Fiellin

  3. Yale University School of Public Health, New Haven, CT, USA

    E. Jennifer Edelman, Sarah K. Calabrese & David A. Fiellin

  4. George Washington University, Washington, DC, USA

    Sarah K. Calabrese

  5. Johns Hopkins University, Baltimore, MD, USA

    Gail Berkenblit

  6. Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA

    Chinazo Cunningham, Viraj Patel & Oni Blackstock

  7. NIDA-IRP, NIH, Baltimore, MD, USA

    Karran Phillips

  8. University of Illinois – Chicago, Chicago, IL, USA

    Minesh Shah

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  1. E. Jennifer Edelman
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Correspondence to E. Jennifer Edelman.

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Conflicts of interest

Dr. Fiellin has received honoraria from Pinney Associates for serving on an external advisory board monitoring the diversion and abuse of buprenorphine. The authors have no other conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was reviewed and considered exempt by both Yale University and Albert Einstein College of Medicine’s Humans Investigation Committees.

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Informed consent was obtained from all individual participants.

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Edelman, E.J., Moore, B.A., Calabrese, S.K. et al. Primary Care Physicians’ Willingness to Prescribe HIV Pre-exposure Prophylaxis for People who Inject Drugs. AIDS Behav 21, 1025–1033 (2017). https://doi.org/10.1007/s10461-016-1612-6

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