Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada

Abstract

Background: Preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine (Truvada) has demonstrated efficacy in placebo-controlled clinical trials involving men who have sex with men, high-risk heterosexuals, serodiscordant couples, and intravenous drug users. To assist in the real-world provision of PrEP, the Centers for Disease Control and Prevention (CDC) has released guidance documents for PrEP use.

Methods: Adult infectious disease physicians were surveyed about their opinions and current practices of PrEP through the Emerging Infections Network (EIN). Geographic information systems analysis was used to map out provider responses across the United States.

Results: Of 1175 EIN members across the country, 573 (48.8%) responded to the survey. A majority of clinicians supported PrEP but only 9% had actually provided it. Despite CDC guidance, PrEP practices were variable and clinicians reported many barriers to its real-world provision.

Conclusions: The majority of adult infectious disease physicians across the United States and Canada support PrEP but have vast differences of opinion and practice, despite the existence of CDC guidance documents. The success of real-world PrEP will likely require multifaceted programs addressing barriers to its provision and will be assisted with the development of comprehensive guidelines for real-world PrEP.

Keywords: HIV; PrEP; providers; survey.

Figure 1.

Geographic distribution of persons based on support of preexposure prophylaxis (PrEP). ArcGIS was utilized to map survey respondents based on the first 3 numbers of the provider's zip code. The number of providers responding was not included for simplicity. Red-colored zip codes contain at least 1 provider who does not support PrEP. Yellow-colored zip codes contain at least 1 provider who is unsure of PrEP. Green-colored zip codes represent at least 1 provider who supports PrEP. Zip codes that include providers with differences of opinion are a combination of colors (ie, orange zip codes have at least 1 provider who does not support PrEP and at least 1 provider who is unsure). Most providers surveyed support PrEP (green). Those who do not support PrEP or are unsure are spread across the country and do not appear to regionally cluster.

Figure 2.

Geographic distribution of persons based on provision of preexposure prophylaxis (PrEP). Very few clinicians have actually provided PrEP (green); a larger percentage would provide PrEP (yellow) and would not provide PrEP (red). For simplicity, providers who commented that PrEP was not relevant to their practice were not included. Interestingly, there were several zip codes that contained providers with polar opinions, including persons who would not provide PrEP and those who would (orange) and providers who would not provide PrEP and those who had (dark red).