2560. Assessing Resident Perspectives on Prescribing Pre-Exposure Prophylaxis for HIV

Abstract

BackgroundOver 15,000 people were living with HIV in Michigan in 2017. Kalamazoo County is one of the ten counties with the highest prevalence rate. Despite the efficacy of pre-exposure prophylaxis (PrEP) and updated guidelines from CDC/USPSTF with daily dosing of oral tenofovir/emtricitabine, 35% of patients encounter a physician who is unwilling to prescribe PrEP. One-third of primary care providers (PCP) are unaware of it. We investigated the perspectives of residents in several primary care-focused residency programs regarding PrEP and barriers to its prescription.MethodsWe surveyed 108 residents at Western Michigan University Homer Stryker M.D. School of Medicine from the departments of Internal Medicine, Medicine-Pediatrics, Pediatrics, Family Medicine, and OB/GYN. An anonymous electronic seven-question survey was sent, accompanied by a brief PrEP guideline.ResultsOf 108 residents surveyed, 53 responded (49%). The majority (45%) were in their intern year (Figure 1). Most respondents (67%) felt somewhat to very comfortable with providing counseling on safe sex practices and HIV prevention (Figure 2). Over 80% of respondents were aware of PrEP prior to reviewing the accompanying guideline. More than 70% of respondents would prescribe PrEP to patients in commercial sex work and serodiscordant couples, but only 30% were willing to prescribe PrEP to heterosexual men or women, and 8% were unwilling to prescribe PrEP at all (Figure 3). The main reason reported for not prescribing PrEP was inadequate knowledge about medication monitoring and follow-up (Figure 4). Only one respondent reported religious or moral beliefs affecting their prescribing habits. The vast majority (98%) of respondents would be more willing to prescribe PrEP with further education.ConclusionThe majority of residents were comfortable with sex education and counseling on HIV prevention, which could help identify at-risk patients. There was wide variation in willingness to prescribe PrEP among indications, but little variation in reasons why PrEP is not being prescribed. This suggests either limited knowledge about the indications or possibly subconscious bias. Our results are consistent with previous literature that additional medical education on PrEP is essential to its utilization by PCPs. Disclosures All authors: No reported disclosures.