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- Title
1286. Healthcare Provider Attitudes and Knowledge Around Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV-Infection in Tennessee.
- Authors
Moore, Emily; Kelly, Sean; Alexander, Leah; Luther, Patrick; Cooper, Robert; Rebeiro, Peter; Zuckerman, Autumn; Hargreaves, Margaret; Bourgi, Kassem; Schlundt, David; Bonnet, Kemberlee; Pettit, April
- Abstract
Background Daily pre-exposure prophylaxis (PrEP) is very effective at preventing HIV acquisition. PrEP use in the southern United States is low despite high regional HIV prevalence. Prior surveys of primary care providers (PCPs) regarding PrEP occurred before recent guideline updates, were not constructed using a theoretical behavioral framework and validated, or did not focus on the South. Methods We conducted a cross-sectional survey of Tennessee (TN) PCPs from March-April 2019 to assess PrEP knowledge, attitudes, and prescribing practices. Survey development was guided by the COM-B framework (capability, opportunity, motivation and behavior) and validated by pilot testing and cognitive interviews. Knowledge scores were calculated as +1 point for each correct option and 0 points for each incorrect option (maximum score=8). Wilcoxon rank-sum tests were used to compare scores, and Fisher's exact tests were used to compare categorical variables, between PrEP prescribers and nonprescribers. Results Among 69 respondents, 39% (n = 27) had prescribed PrEP. There were no differences in beliefs about PrEP or sense of obligation to prescribe PrEP between prescribers and nonprescribers. Patient inquiry about PrEP was significantly associated with prescription (P < 0.001); 100% of prescribers had ≥1 patient ask about PrEP in the past year vs. 29% of nonprescribers. Prescribers' median PrEP knowledge scores were higher than nonprescribers' (Figure 1). Prescribers had higher self-reported ability to take sexual histories for MSM and heterosexual male patients than nonprescribers (P = 0.007, P = 0.007), and higher self-reported comfort with taking sexual histories for MSM, heterosexual male, and heterosexual female patients (P = 0.061, P = 0.005, P = 0.026, respectively). Nonprescribers frequently cited a need for training in PrEP contraindications and eligibility, cost of PrEP, and administrative burden as barriers to provision. Conclusion Less than half of TN PCPs we surveyed prescribed PrEP despite similar senses of obligation and PrEP-related beliefs between prescribers and nonprescribers. Future interventions to improve PrEP provision among PCPs in TN should target PrEP knowledge, ability and comfort with sexual history taking, and patient awareness of and ability to inquire about PrEP. Disclosures All authors: No reported disclosures.
- Subjects
TENNESSEE; PRE-exposure prophylaxis; MEDICAL personnel; FISHER exact test; COGNITIVE testing; COGNITIVE interviewing; WOMEN patients
- Publication
Open Forum Infectious Diseases, 2019, Vol 6, pS463
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofz360.1149