Primary Care Doc Education May Increase PrEP Prescribing

Educating primary care clinicians about the critical role they play in prescribing medications to prevent HIV can increase their likelihood of doing so, researchers have found.

While infectious disease clinicians traditionally have a high-level of training in HIV and preexposure prophylaxis (PrEP), many patients who could benefit never make it to one of these specialists. Primary care clinicians, meanwhile, see a range of patients and are trained in screening and preventive care.

“Primary care providers feel as though PrEP prescribing is outside of their purview and defer to an infectious diseases specialist,” Margaret Pertzborn, PharmD, an infectious diseases pharmacy resident at Virginia-based health system Carilion Clinic, told Medscape Medical News. “But the infectious diseases specialists feel that PrEP is better managed by the primary care providers since it’s a preventative and lifestyle treatment.”

New HIV infections have dropped over time. Between 2015 and 2019 they decreased by 8%, according to the US Centers for Disease Control and Prevention (CDC). Meanwhile, the CDC estimates that 1.2 million Americans could potentially benefit from PrEP. The agency updated its clinical practice guidelines in 2021 to recommend that all sexually active adults and adolescents are counseled on PrEP, which includes drugs such as cabotegravir, and emtricitabine and tenofovir.

Digital Toolkits

In 2021, Pertzborn and colleagues created PrEP educational toolkits and distributed them to over 200 ambulatory clinics in the Carilion system. The digital materials reached about 500 primary care clinicians and included an overview of PrEP, as well as prescribing guidelines and affordability.

The researchers compared prescription data before and after the intervention. Although new prescriptions for PrEP didn’t increase overall, the number of clinics and primary care physicians who prescribed the drugs rose.

“It shows that an intervention such as this gives them the knowledge they need to provide the treatment,” Pertzborn said. “It’s a passive education resource and doesn’t require much upkeep.”

The researchers also noted an overall increase in primary care clinicians testing patients for sexually transmitted diseases, another benefit for patient health. Pertzborn presented the findings May 19 at the Making a Difference in Infectious Diseases 2022 annual meeting in Orlando, Florida. 

Previous studies suggest that primary care doctors don’t prescribe PrEP because they say they don’t know enough about the drugs, how to tell if a patient might benefit, or how to manage patients over the long term. 

“Providers thought that it would enable patients to engage in risky behaviors if they prescribed it,” said Leah Turner, CRNP, clinical coordinator at the MacGregor Infectious Diseases Clinic at University of Pennsylvania’s Division of Infectious Diseases, Philadelphia. “There are also logistical concerns on the time needed for counseling and follow-up related to PrEP.”

Turner, who was not affiliated with Pertzborn’s study, said primary care clinicians are seeing patients for a variety of reasons, with much shorter appointment times than specialists.

“The other part of education should focus on dispelling some of the beliefs that may be unfounded,” said Turner, who published a 2017 review of studies on the attitudes of primary care clinicians on PrEP.

One of those misconceptions Pertzborn addressed were the views of primary care clinicians in regard to a patient’s out-of-pocket PrEP costs. Pertzborn and her team ultimately relayed information to clinicians that most insurers, including Medicaid, cover the treatment at no cost. A variety of copay and PrEP assistance programs can help defray the cost to patients, according to the CDC.

Pertzborn and Turner reported no relevant financial relationships.

Making a Difference in Infectious Diseases 2022 annual meeting: Abstract 15 OR FRS. Presented May 19, 2022.

Lara Salahi is a journalist living in Boston.

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