Prescribing of Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis by HIV Medical Providers in the United States, 2013-2014.

Abstract

Clinical trials have demonstrated the effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) for reducing HIV acquisition. Understanding how HIV care providers are prescribing PrEP is necessary to ensure success of this prevention strategy. During 2013-2014, we surveyed US HIV care providers who also provided care to HIV-negative patients. We estimated percentages who had prescribed PrEP and assessed associations between provider characteristics and PrEP prescribing. An estimated 26% (95% confidence interval [CI], 20-31) had ever prescribed PrEP. Of these, 74% (95% CI, 61-87) prescribed for men who have sex with men (MSM), 30% (95% CI, 21-39) for women who have sex with men, 23% (95% CI, 9-37) for men who have sex with women, 23% (95% CI, 15-30) for uninfected partners in HIV-discordant couples trying to conceive, and 1% (95% CI, 0-2) for persons who inject drugs. The following provider characteristics were significantly associated with having prescribed PrEP: male vs female (32% vs 16%; adjusted prevalence ratio [aPR], 1.5; 95% CI, 1.0-2.2), lesbian/gay/bisexual vs heterosexual orientation (50% vs 21%; aPR, 2.0; 95% CI, 1.3-2.9), and HIV caseload (>200, 51-200, and ≤50 patients, 39%, 29%, and 14%, respectively; >200 vs ≤50 patients, aPR 2.4, 95% CI 1.1-5.2, and 51-200 vs ≤50 patients, aPR 2.2, 95% CI 1.2-4.0). In 2013-2014, one quarter of HIV care providers reported having prescribed PrEP, most commonly for MSM and rarely for persons who inject drugs. Lesbian/gay/bisexual providers and male providers were more likely than others to have prescribed PrEP. Additional efforts may enable more providers to prescribe PrEP to underserved clients needing the service.