title: A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians.
abstract: Among health care providers, prescription of HIV pre-exposure prophylaxis (PrEP) has been low. Little is known specifically about primary care physicians (PCPs) with regard to PrEP awareness and adoption (i.e., prescription or referral), and factors associated with adoption.
  
  
  
  To assess PrEP awareness, PrEP adoption, and factors associated with adoption among PCPs.
  
  
  
  Cross-sectional online survey conducted in April and May 2015.
  
  
  
  Members of a national professional organization for academic primary care physicians (n = 266).
  
  
  
  PrEP awareness, PrEP adoption (ever prescribed or referred a patient for PrEP [yes/no]), provider and practice characteristics, and self-rated knowledge, attitudes, and beliefs associated with adoption.
  
  
  
  The survey response rate was 8.6 % (266/2093). Ninety-three percent of respondents reported prior awareness of PrEP. Of these, 34.9 % reported PrEP adoption. In multivariable analysis of provider and practice characteristics, compared with non-adopters, adopters were more likely to provide care to more than 50 HIV-positive patients (vs. 0, aOR = 6.82, 95 % CI 2.06-22.52). Compared with non-adopters, adopters were also more likely to report excellent, very good, or good self-rated PrEP knowledge (15.1 %, 33.7 %, 30.2 % vs. 2.5 %, 18.1 %, 23.8 %, respectively; p < 0.001) and to perceive PrEP as extremely safe (35.1 % vs. 10.7 %; p = 0.002). Compared with non-adopters, adopters were less likely to perceive PrEP as being moderately likely to increase risk behaviors ("risk compensation") (12.8 % vs. 28.8 %, p = 0.02).
  
  
  
  While most respondents were aware of PrEP, only one-third of PrEP-aware PCPs reported adoption. Adopters were more likely to have experience providing HIV care and to perceive PrEP as extremely safe, and were less likely to perceive PrEP use as leading to risk compensation. To enhance PCP adoption of PrEP, educational efforts targeting PCPs without HIV care experience should be considered, as well as training those with HIV care experience to be PrEP "clinical champions". Concerns about safety and risk compensation must also be addressed.
authors: Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA. oblackst@montefiore.org.
authors: Oni J
authors: OJ
authors: Blackstock
authors: Yale University School of Medicine, New Haven, CT, USA.
authors: Brent A
authors: BA
authors: Moore
authors: Johns Hopkins University, Baltimore, MD, USA.
authors: Gail V
authors: GV
authors: Berkenblit
authors: Yale University School of Public Health, New Haven, CT, USA.
authors: Sarah K
authors: SK
authors: Calabrese
authors: Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
authors: Chinazo O
authors: CO
authors: Cunningham
authors: Yale University School of Medicine, New Haven, CT, USA.|Yale University School of Public Health, New Haven, CT, USA.
authors: David A
authors: DA
authors: Fiellin
authors: Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
authors: Viraj V
authors: VV
authors: Patel
authors: NIDA-Intramural Research Program, NIH, Baltimore, MD, USA.
authors: Karran A
authors: KA
authors: Phillips
authors: Yale University School of Medicine, New Haven, CT, USA.
authors: Jeanette M
authors: JM
authors: Tetrault
authors: University of Illinois-Chicago, Chicago, IL, USA.
authors: Minesh
authors: M
authors: Shah
authors: Yale University School of Medicine, New Haven, CT, USA.|Yale University School of Public Health, New Haven, CT, USA.
authors: E Jennifer
authors: EJ
authors: Edelman
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education; D000073599:Health Risk Behaviors; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents
keywords: HIV prevention; implementation; pre-exposure prophylaxis; primary care physicians