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

Abstract

Abstract Background 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. Methods 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. Results 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). Conclusions 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.