title: Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada.
abstract: BACKGROUND
  Preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine (Truvada) has demonstrated efficacy in placebo-controlled clinical trials involving men who have sex with men, high-risk heterosexuals, serodiscordant couples, and intravenous drug users. To assist in the real-world provision of PrEP, the Centers for Disease Control and Prevention (CDC) has released guidance documents for PrEP use.
  
  
  METHODS
  Adult infectious disease physicians were surveyed about their opinions and current practices of PrEP through the Emerging Infections Network (EIN). Geographic information systems analysis was used to map out provider responses across the United States.
  
  
  RESULTS
  Of 1175 EIN members across the country, 573 (48.8%) responded to the survey. A majority of clinicians supported PrEP but only 9% had actually provided it. Despite CDC guidance, PrEP practices were variable and clinicians reported many barriers to its real-world provision.
  
  
  CONCLUSIONS
  The majority of adult infectious disease physicians across the United States and Canada support PrEP but have vast differences of opinion and practice, despite the existence of CDC guidance documents. The success of real-world PrEP will likely require multifaceted programs addressing barriers to its provision and will be assisted with the development of comprehensive guidelines for real-world PrEP.
authors: Department of Internal Medicine, University of California San Diego, La Jolla.
authors: Maile Y
authors: MY
authors: Karris
authors: Susan E
authors: SE
authors: Beekmann
authors: Sanjay R
authors: SR
authors: Mehta
authors: Christy M
authors: CM
authors: Anderson
authors: Philip M
authors: PM
authors: Polgreen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D018890:Chemoprevention / Q000379:methods / Q000706:statistics & numerical data*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004338:Drug Combinations; D000069480:Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009943:Organophosphorus Compounds / Q000627:therapeutic use*; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D014481:United States / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations; D000069480:Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination; D009943:Organophosphorus Compounds; D003841:Deoxycytidine
keywords: HIV; PrEP; providers; survey