Physicians who treat patients with HIV understand that preexposure prophylaxis (PrEP) is effective in preventing infections. In a recent survey, most said they initiate discussions with patients and would prescribe for high-risk people, according to a poster presented at IDWeek 2024.

The uptake of PrEP for HIV has increased but is still not reaching patients who could benefit. In 2022, 36% of the 1.2 million people who could benefit from PrEP were prescribed it, compared with 23% in 2019, according to the Centers for Disease Control and Prevention (CDC). But disparities exist. Only 13% of Black and 24% of Latino people who could benefit have been prescribed PrEP, and the HIV infection rate is higher in those populations than in the White population. Women are also underrepresented among those who receive HIV PrEP.

The “Ending the HIV Epidemic in the U.S.” initiative began in 2019, with the goal of reducing new HIV infections by 90% by 2030. Access to PrEP plays a big part in this initiative.

PrEP reduces the risk of getting HIV from sex by about 99% and reduces the risk of getting HIV from injection drug use by at least 74%, according to the CDC. Several medications for HIV PrEP are available. Gilead markets two oral medications, Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine/tenofovir alafenamide). ViiV Healthcare markets Apretude (cabotegravir), a long-acting injectable for PrEP.

In the poster presented at IDWeek 2024, researchers wanted to assess the factors that healthcare providers consider when recommending or prescribing PrEP. Ricky K. Hsu, M.D., medical director at the AIDS Healthcare Foundation and a clinical associate professor at NYU Grossman School of Medicine, and his colleagues developed a 50-question survey about PrEP for physicians.

The survey was administered through the Chorus platform, a web-based clinical decision support system for healthcare providers, between Oct. 4, 2023, and July 12, 2024. Among the 167 healthcare providers who completed the survey, 110 were prescribers.

Knowledge of PrEP and understanding the effectiveness of the medications was high among those who responded to the survey. Condomless sex and a diagnosis of a sexually transmitted disease were important considerations for recommending PrEP. Among prescribers, all said they would be very likely or extremely likely to prescribe PrEP for people at high risk for HIV.

However, a separate poster presented at IDWeek highlighted the knowledge discrepancy among some healthcare providers. In this survey of 88 faculty, residents and fellows at Louisiana State University Health Sciences Center Shreveport, most participants rated their knowledge of PrEP as fair, and 73% had never prescribed PrEP. More than 34% said they would be slightly or not comfortable prescribing PrEP.

Other barriers to prescribing PrEP include lack of insurance coverage and patient costs, staff constraints related to PrEP adherence counseling, clinical and lab monitoring requirements, and lack of clinical guidelines for prescribing and monitoring PrEP.

In 2022, Louisiana ranked fourth in the nation for HIV diagnosis rates, according to the Louisiana Department of Health. New cases of HIV in the state are down, the health department reported, although individuals in minority groups face significant health disparities. In 2023, 68%of people newly diagnosed with HIV and 69% of people newly diagnosed with AIDS were Black.