title: Diffusion of Newer HIV Prevention Innovations: Variable Practices of Frontline Infectious Diseases Physicians.
abstract: BACKGROUND
  US Public Health Service guidelines recommend early initiation of antiretroviral treatment (ART) for human immunodeficiency virus infection (HIV)-infected patients and preexposure prophylaxis (PrEP) as a prevention option for persons at risk for HIV acquisition. Before issuance of these guidelines, few clinicians reported prescribing early ART or PrEP.
  
  
  METHODS
  The Emerging Infections Network, a national network of infectious diseases physicians in the United States and Canada, was surveyed in September 2014 to assess practices of adult HIV-care providers with early ART, PrEP, and other guideline-recommended HIV prevention methods.
  
  
  RESULTS
  Almost half of the 1191 active members invited (48.1%) participated; 415 (72.4%) were HIV-care providers. Most providers (86.5%) indicated that they typically recommended ART initiation at diagnosis, irrespective of CD4(+) cell count. However, for patients with a CD4(+) cell count >500/µL, clinicians would defer ART if patients did not feel ready to initiate ART (94.7%) or had uncontrolled substance abuse (66.0%). Many providers had counseled HIV-infected patients about PrEP for partners (59.0%) or offered visits for partners to discuss PrEP (40.7%), and 31.8% had prescribed PrEP. Clinicians who deferred ART were less likely to endorse and engage in aspects of PrEP provision.
  
  
  CONCLUSIONS
  Concordant with guidelines, most infectious diseases physicians recommend early ART, and many have experience with aspects of PrEP provision, suggesting recent evolution of clinician practices. Providers who defer ART are also cautious about PrEP. Interventions that help physicians motivate patients to initiate ART and identify missed opportunities to provide PrEP could enhance HIV prevention.
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center.|The Fenway Institute, Fenway Health, Boston, Massachusetts.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Krakower
authors.affiliation: Departments of Internal Medicine.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Beekmann
authors.affiliation: Departments of Internal Medicine.|Epidemiology, University of Iowa Carver College of Medicine, Iowa City.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Polgreen
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center.|The Fenway Institute, Fenway Health, Boston, Massachusetts.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002170:Canada; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D055552:Infectious Disease Medicine / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends*; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV prevention; early antiretroviral treatment; healthcare provider; preexposure prophylaxis