Knowledge of PrEP Increasing in Primary Care

The number of physicians and nurse practitioners aware of HIV pre-exposure prophylaxis (PrEP) and its potential benefits has increased dramatically in the years since it was first introduced to the market, a survey conducted by the Centers for Disease Control and Prevention (CDC) has confirmed.

The national survey of clinicians across multiple specialties, the results of which were published online on June 3 by the journal PLOS One, assessed knowledge of PrEP among 9,000-plus survey respondents over a 6-year period, from 2009 to 2015. Tenofovir/emtricitabine (Truvada, Gilead Sciences), the drug that serves as the underpinnings for PrEP, was approved by the US Food and Drug Administration (FDA) in 2012, and the CDC published guidelines for its use in 2014.

“There are many new clinical treatments introduced every year that clinicians who provide preventive care for a wide range of health conditions have to learn about and then incorporate into their practices,” study-co-author Dawn K. Smith, MD, MS, MPH, Division of HIV/AIDS Prevent, CDC, told Contagion. “Despite this rapidly changing evidence base for clinical care, among both primary care and HIV-specialist clinicians, awareness of PrEP has increased steadily… in the five years since the first effectiveness data was published and the two years since CDCs guidelines were published. In fact, the gain in awareness among primary care clinicians has been faster than I would have predicted.”

Indeed, Dr. Smith and her colleagues surveyed 1,500 physicians and nurse practitioners in 2009; 1,504 in 2010; 1,503 in 2012; 1,507 in 2013; 1,508 in 2014; and 1,501 last year (in 2015) to assess their awareness of PrEP, their willingness to prescribe it, and whether or not they support use of public funds to help those in need pay for it. (Currently, the manufacturer as well as several patient advocacy groups offer financial assistance to those who cannot afford the costs of PrEP treatment.) Not surprisingly, they found that awareness of PrEP was low among clinicians in 2009 (24%) and 2010 (29%), prior to the drug’s approval by the FDA. However, after clinical trials demonstrated its safety and efficacy, and it had received approval, awareness increased dramatically, to 49% in 2012, 51% in 2013, 61% in 2014, and 66% last year. Over the 6-year study period, 91% of the clinicians surveyed indicated a willingness to prescribe PrEP to those at high risk of HIV infection. A high of 63% in 2013 (the last year for which data were available) indicated that they supported the use of public funds for PrEP to assist those who lacked the financial resources necessary to acquire treatment on their own.

“The CDC is working with a range of partners on several initiatives to increase clinician awareness and delivery of PrEP to patients who would benefit from it,” Dr. Smith said. “This includes working with professional medical and community health care associations to disseminate the PrEP clinical practice guidelines, developing and disseminating a toolkit for clinicians new to PrEP delivery, and conducting demonstration projects with health departments and community health centers to expand the number of clinicians providing PrEP.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.