Lack of clinical training, misconceptions about HIV are barriers to PrEP in the South

November 04, 2022

2 minute read



Traylor, D. Prescribing PrEP by Southern US Primary Care Providers. Presented at: OMED22; Oct. 27-31, 2022; Boston.

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In a recent survey, most primary care physicians in the South do not screen patients for HIV pre-exposure prophylaxis eligibility or write prescriptions for it.

A lack of clinical training and misconceptions surrounding HIV resistance to pre-exposure prophylaxis (PrEP) were among the barriers to testing and prescribing, according to the survey.

Data taken from: Traylor, D. Prescribing PrEP by Southern US Primary Care Providers. Presented at: OMED22; Oct. 27-31, 2022; Boston.

Presentation at the OMED conference of the American Osteopathic Association, Daryl O. Traylor, MS, MPH, PhD, a medical student at the University of the Word Embodied School of Osteopathic Medicine in San Antonio, noted that while PrEP “is very effective against HIV when taken as prescribed,” only 953 African Americans du Sud received PrEP prescriptions in 2018.

“Primary care providers are missing key opportunities to screen for PrEP needs, as well as prescribe PrEP,” he said, noting that research on barriers remains confusing.

In the United States, HIV is most prevalent in the South. According to the CDC, from 2015 to 2019, the South recorded 96,000 new HIV infections, 58,100 more than the West, the second highest region. African-American patients are disproportionately affected, accounting for more than half of all new infections from 2018 to 2019, Traylor said.

For the cross-sectional study, Traylor used the Transtheoretical Stages of Change Model to examine patterns and characteristics of PrEP assessments and prescribing in primary care practices in the southern United States.

The study cohort included 223 PCPs in 10 Southern states who had an average age of 44; 57.8% were male (n=129). More than half of the participants practiced in Texas and the majority practiced in an urban setting.

Traylor found that 32.3% of PCPs (n=72) were not prescribing PrEP and did not intend to prescribe PrEP within 6 months, while 16.6% (n=37) were not prescribing not PrEP but intended to do so within 6 months. About thirty percent (n=69) had prescribed PrEP for more than 6 months.

According to participants’ responses – which were ranked using a Leichter scale from 1 (not important) to 5 (extremely important) – the most significant barriers to prescribing PrEP included:

  • lack of PrEP training for providers (average score, 4.27);
  • a lack of clinical guidelines on PrEP (mean score, 3.87);
  • staff and time constraints (mean score, 4.29); and
  • a lack of insurance coverage and high disbursements (mean score, 4.7).

Notable facilitators included patient motivation (mean score, 4.25) and access to PrEP resources (mean score, 3.63), Traylor said. Meanwhile, gay, bisexual, and lesbian patient characteristics were among the most negative variables predicting PrEP prescription or non-prescription.

Traylor also reported that PCPs with 50% or more African American patients were more likely to have prescribed PrEP than those with 50% or fewer African American patients (73% versus 37%). Meanwhile, 63% (n=115) of PCPs who had 50% or fewer African American patients were never prescribed PrEP.

Traylor concluded that both the lack of provider training and clinical guidelines, as well as misconceptions surrounding PrEP and HIV resistance underscore “the need for more physician training.”


About Bradley J. Bridges

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