(P304) Examining Provider Attitudes and Barriers Towards Prescribing PrEP within Primary Care Settings in the Southern United States

Background: HIV Pre-exposure Prophylaxis (PrEP) is an effective HIV prevention tool. The “prescriber’s paradox” often relegates PrEP to infectious diseases specialists. Access to PrEP could be expanded if primary care providers (PCPs) such as family medicine (FM) and internal medicine (IM) providers incorporate inclusive and affirming PrEP services into their clinical practices. Expanding access would make great strides toward ending the HIV epidemic. This study explores the attitudes and barriers towards prescribing PrEP among PCPs in Alabama, where there is high HIV burden with low PrEP uptake.

Methods: Grounded in the Health Belief Model, we are conducting in-depth interviews exploring provider experiences in sexual history-taking practices and prescribing PrEP. This study is ongoing, with plans to enroll a total of 20 PCPs practicing in Alabama. We recruited physicians who are currently training or completed their residency at UAB, and we plan to utilize these connections to recruit advanced practice providers for study participation as well. We plan for the final participant population to have experience practicing in various practice settings. Primary thematic analysis has been performed by the research team and will continue iteratively as themes emerge through the course of the study.

Results: To date, two IM physicians in urban group private practice, one IM physician in rural private practice, and two IM resident physicians have enrolled. Preliminary data revealed barriers towards prescribing PrEP found in 100% (n=5) of interviews were time constraints and competing priorities. Furthermore, 100% (n=5) of interviews believed PrEP belongs in primary care due to access of PCPs to the general population and that it could be best implemented as health maintenance.

Conclusion: Preliminary themes demonstrate interest in incorporating PrEP provision into primary care, but time constraints and competing priorities are barriers to this. Sexual healthcare, including PrEP provision, should be universal, non-stigmatized, and unseparated from a patient’s general health maintenance. This would allow for discussion of sexual health, including PrEP, to have easier integration into a primary care setting and effectively increase PrEP uptake.