Primary Care Physician Attitudes and Intentions Toward the Use of HIV Pre-exposure Prophylaxis in Adolescents in One Metropolitan Region

Tanya L Kowalczyk Mullins; Caitlyn R Idoine; Gregory D Zimet; Jessica A Kahn

doi:10.1016/j.jadohealth.2018.10.300

Primary Care Physician Attitudes and Intentions Toward the Use of HIV Pre-exposure Prophylaxis in Adolescents in One Metropolitan Region

J Adolesc Health. 2019 May;64(5):581-588. doi: 10.1016/j.jadohealth.2018.10.300. Epub 2018 Dec 19.

Authors

Tanya L Kowalczyk Mullins¹, Caitlyn R Idoine², Gregory D Zimet³, Jessica A Kahn⁴

Affiliations

¹ Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: tanya.mullins@cchmc.org.
² Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
³ Division of Adolescent Medicine, Indiana University, Indianapolis, Indiana.
⁴ Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Abstract

Purpose: Understanding the attitudes of physicians toward the use of pre-exposure prophylaxis (PrEP) for HIV prevention among youth is critical to improving access to PrEP. We examined PrEP-related attitudes among physicians who provide primary care to 13- to 21-year-old adolescents.

Methods: Individual, in-depth, semistructured interviews were conducted with 38 physicians from adolescent medicine, family practice, internal medicine/medicine-pediatrics, obstetrics/gynecology, and pediatrics who care for any adolescents younger than 18 years. Interviews assessed familiarity with PrEP, perceived benefits and barriers to providing PrEP to adolescents, facilitating factors for prescribing PrEP, and likelihood of recommending and prescribing PrEP to adolescents.

Results: Mean age was 44.6 years (standard deviation 10.9). Fourteen physicians (37%) reported being somewhat or very familiar with PrEP. Perceived benefits of prescribing PrEP included decreased acquisition/rates of HIV, improved provision of sexual health services, and improved patient awareness of HIV risk. Barriers to PrEP were reported at the patient (e.g., lack of acceptability to patients), provider (e.g., concerns about patient adherence, safety/side effects, parents as a barrier to PrEP use), and system (e.g., high cost) levels. Facilitating factors for prescribing PrEP included low cost/coverage by insurance, physician education about PrEP, patient educational materials, and clinical guidelines for PrEP use in youth. A higher proportion of physicians reported being highly or somewhat likely to recommend (N = 16, 42%) than prescribe PrEP (N = 13, 34%).

Conclusions: In this study of primary care physician attitudes toward PrEP prescribing for adolescents, physicians identified numerous barriers to providing PrEP. Addressing these barriers may increase adolescents' access to PrEP.

Keywords: Adolescent; HIV; Physicians; Prevention; Prophylaxis.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Attitude of Health Personnel*
Female
HIV Infections / prevention & control*
Humans
Intention*
Male
Patient Acceptance of Health Care / psychology
Physicians, Primary Care* / psychology
Physicians, Primary Care* / statistics & numerical data
Practice Patterns, Physicians'
Pre-Exposure Prophylaxis*
Sexual Health
Surveys and Questionnaires

Grants and funding

K23 HD072807/HD/NICHD NIH HHS/United States