Awareness of and support for the use of Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) has risen steadily among U.S. physicians and nurse practitioners (NPs). Publishing their findings in PLOS ONE, researchers conducted PrEP-related surveys in 2009, 2010, 2012, 2013, 2014 and 2015 among physicians and NPs, with about 1,500 respondents each year.
PrEP’s efficacy among men who have sex with men (MSM) was first proved in 2010. It was approved for use in the United States in 2012. Because the first two surveys in this study predated the publication of PrEP’s efficacy, the researchers told the respondents to consider the HIV prevention method a theoretical 75 percent effective. Subsequently, research showed that among those with high self-reported adherence, PrEP’s effectiveness was in fact 75 percent. (Self-reported adherence is not the same as actual adherence. There has to date been only one confirmed case of an individual contracting HIV while adhering well to the daily Truvada regimen.)
Awareness of PrEP rose from 24 percent in 2009 to 29 percent in 2010, 49 percent in 2012, 51 percent in 2013, 61 percent in 2014 and 66 percent in 2015.
The proportion of physicians who said they supported public funding of PrEP was 59 percent in 2009, 53 percent in 2010 and 63 percent in 2013.
Across all five survey years, 91 percent of clinicians supported prescribing PrEP to one or more high-risk groups. Seventy-nine percent supported PrEP for an HIV-negative member of a mixed-HIV status couple, 66 percent did so for MSM, 63 percent did so for injection drug users, 61 percent did so for mixed-HIV status couples looking to conceive a child, 56 percent did so for individuals with multiple sexual partners and 34 percent did so for people diagnosed with a sexually transmitted infection.
After adjusting the data for various factors, the researchers found that only five factors were related to clinicians’ willingness to prescribe PrEP to one or more high-risk groups; this relationship was only modest on all counts. Compared with family physicians, OB/GYNs were slightly more willing to prescribe PrEP, as were clinicians in group practice compared with those practicing individually. Clinicians with practices including more than 20 health care providers were slightly less willing to prescribe PrEP than those in practices with four or fewer providers, as were clinicians between 45 and 54 years old compared with those 55 and older. Those who had prescribed antiretrovirals as HIV treatment or post-exposure prophylaxis (PEP) also had a slightly increased likelihood of being willing to prescribe PrEP.
To read the study abstract, click here.