1284. Pre-exposure Prophylaxis (PrEP) for HIV in Vermont: an Assessment of Prescribing in a Uniquely Rural State

Abstract

BackgroundIn the United States and Vermont, men who have sex with men (MSM) make up the majority of new human immunodeficiency virus (HIV) infections every year. Despite HIV prevention campaigns and approval of antiviral therapy for pharmacologic HIV pre-exposure prophylaxis (PrEP), HIV cases in Vermont—a predominantly rural state—are on the rise. The primary objective of this study was to assess prescribing practices and barriers surrounding PrEP for adult MSM in Vermont.MethodsA web-based healthcare provider survey was deployed electronically over a 10 week period in 2019 to a convenience sample of licensed primary care, sexual health, and infectious disease providers in Vermont. Questions were designed to target factors thought to influence PrEP prescribing, with a focus on prescribing behaviors and perceived barriers.ResultsAn estimated 500 providers received the survey. There were 137 survey respondents, 106 (77%) were physicians, primarily in internal medicine. Though only 47 (34%) providers had experience prescribing PrEP to MSM patients, over 89% identified as willing to prescribe PrEP to high-risk groups. Among PrEP prescribers, screening frequency for HIV and bacterial sexually transmitted infections (STIs) while on PrEP fell below the current guideline recommendations at 72% and 53%, respectively. Less than 70% of providers routinely obtain sexual history for male patients. Among providers willing to prescribe PrEP, concern regarding medication toxicity was the only statistically significant barrier (χ 2 = 5.5, P = 0.02). Concerns regarding risk compensation behavior and lack of knowledge or experience regarding prescribing PrEP also demonstrated an association with provider willingness to prescribe PrEP, however did not reach statistical significance.ConclusionThe majority of Vermont providers sampled are willing to prescribe PrEP, suggesting there is great opportunity to increase prescribing and use, potentially having an impact on reducing HIV transmission among MSM in the state. Provider education targeted toward guidelines for STI and HIV screening on therapy, obtaining sexual histories, and minimal toxicity risk may serve to increase prescribing of PrEP among Vermont providers.Disclosures All authors: No reported disclosures.