title: Understanding HIV Care Provider Attitudes Regarding Intentions to Prescribe PrEP.
abstract: BACKGROUND
  Preexposure prophylaxis (PrEP) is a promising approach to reducing HIV incidence. So, garnering the support of HIV providers, who are most familiar with antiretrovirals and likely to encounter patients in HIV serodiscordant relationships, to scale-up PrEP implementation is essential. We sought to determine whether certain subgroups of HIV providers were more likely to intend to prescribe PrEP.
  
  
  METHODS
  Surveys were administered to HIV providers in Miami, Florida and Washington, District of Columbia. Composite scores were developed to measure PrEP knowledge, experience, and likelihood of prescribing. Latent class analysis was used to stratify provider attitudes toward PrEP.
  
  
  RESULTS
  Among 142 HIV providers, 73.2% had cared for more than 20 HIV-infected patients in the previous 3 months; 17% had ever prescribed PrEP. Latent class analysis identified 2 classes of providers (entropy, 0.904); class 1 (n = 95) found PrEP less effective and perceived barriers to prescribing it; class 2 (n = 47) perceived PrEP as moderately effective and perceived fewer barriers to prescribing it. Compared with class 2, class 1 had significantly less experience with PrEP delivery (t(22.7) = 2.88, P = 0.009) and was significantly less likely to intend to prescribe to patients with multiple sex partners (20% vs. 43%, P = 0.04) and those with a drug use history (7% vs. 24%, P = 0.001).
  
  
  CONCLUSIONS
  Although most HIV providers found PrEP to be effective, those considering it less effective had limited knowledge and experience with PrEP and had lesser intentions to prescribe. Provider training regarding whom should receive PrEP and addressing potential barriers to PrEP provision are needed if this HIV prevention method is to be optimized.
authors.affiliation: *Department of Epidemiology and Biostatistics, The Milken Institute School of Public Health, George Washington University, Washington, DC; †Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; ‡Florida Department of Health, Miami-Dade County, Miami, FL; §District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, TB Administration, Washington, DC; ‖Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; and ¶Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Castel
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feaster
authors.forename: Wenze
authors.initials: W
authors.lastname: Tang
authors.forename: Sarah
authors.initials: S
authors.lastname: Willis
authors.forename: Heather
authors.initials: H
authors.lastname: Jordan
authors.forename: Kira
authors.initials: K
authors.lastname: Villamizar
authors.forename: Michael
authors.initials: M
authors.lastname: Kharfen
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kolber
authors.forename: Allan
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Metsch
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D065129:Pre-Exposure Prophylaxis
chemical_list: D019380:Anti-HIV Agents