Why are Clinicians Reluctant to Prescribe PrEP to High-Risk Patients?

A survey by the American Academy of HIV Medicine found that less than half of healthcare providers reported being “very likely” to prescribe pre-exposure prophylaxis (PrEP) to high-risk patients despite the U.S. Public Health Service’s PrEP guidelines. The results appear in the association’s publication HIV Specialist.

Via a web-based 53-question survey, 324 American Academy of HIV Medicine members were polled on their prescribing habits of PrEP for high-risk patients. While less than half stated that they would be “very likely” to prescribe PrEP to patients who are high-risk heterosexuals or people who use intravenous drugs, 79% would be “very likely” to prescribe PrEP to HIV-negative men whose male partners have the virus.

Reasons listed for reluctance in prescribing PrEP included concerns about the following:

Medication adherence
Regular follow-up care for monitoring and counseling
Effectiveness of PrEP in preventing HIV
Side effects
Patients engaging in riskier behaviors
Cost of treatment

Study co-author Kathy Brown, MD, noted that although there were initial concerns about an increase in risky behavior, side effects, drug resistance, and adherence with PrEP, recent real-world studies do not support these concerns. Healthcare providers need ongoing education and guidance regarding practical issues associated with prescribing PrEP, she added.

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