ID Docs Back Preexposure HIV Prophylaxis, Yet Few Provide It

Steven Fox

January 02, 2014

Nearly 75% of infectious disease specialists across the United States and Canada support the use of preexposure prophylaxis (PrEP) against HIV, but fewer than 1 in 10 have actually provided that service, according to results from a newly published survey.

Findings of the survey appear in an article published online December 6, 2013, in Clinical Infectious Diseases.

"[PrEP] with tenofovir disoproxil fumarate and emtricitabine [Truvada, Gilead] has demonstrated efficacy in placebo controlled clinical trials involving men who have sex with men, high risk heterosexuals, serodiscordant couples and intravenous drug users," write Maile Y. Karris, MD, Department of Internal Medicine, University of California, San Diego, La Jolla, and colleagues.

The US Public Health Service has not yet issued comprehensive guidelines regarding when and how to use PrEP. In the meantime, to promote use of PrEP, the Centers for Disease Control and Prevention (CDC) has published its own set of guidelines that cover topics such as how to determine eligibility for PrEP, how and when to initiate the treatment, how to follow-up patients, and when necessary, how to discontinue treatment.

Results from recent studies have raised concerns about the feasibility and efficacy of using PrEP in real-world settings, the authors note.

The researchers surveyed a wide range of infectious disease specialists who were based throughout the United States and Canada to learn more about their opinions regarding PrEP, including whether they currently used it or were prepared to use it.

Respondents worked in a variety of settings, including hospitals/clinics, private practice, universities/medical schools, and the military/US Department of Veterans Affairs. The surveys were conducted during the summer of 2013.

Among the 573 specialists who responded to the survey, 74% said they supported the CDC guidelines for PrEP, 14% remained unsure, and 12% did not support PrEP.

However, the researchers note, "Despite this strong support for PrEP only 9% had actually provided PrEP, 43% had not provided PrEP but would, 34% believed PrEP was not relevant to their practice and 14% would not provide PrEP."

Reasons for lack of support for PrEP varied. More than three quarters (77%) of those opposed to PrEP said they were concerned about adherence to therapy and the potential for development of future resistance.

Among other concerns were cost and reimbursement issues (57%), the use of potentially toxic drugs in healthy individuals (53%), and insufficient proof of efficacy for real-world use of PrEP (53%).

"These results reveal that while PrEP acceptability is high, the uptake and practice is still low and perception persists that multiple barriers exist to adequately provide PrEP," the researchers conclude. "These concerns may not be abated with increased provider education as has been recommended by previous studies, but most likely requires the completion of ongoing open-label PrEP studies, future studies of real-world PrEP implementation and an increase in the collective experiences of healthcare providers."

This study was supported by the National Institutes of Health and the Centers for Disease Control and Prevention. The authors have disclosed no relevant financial relationships.

Clin Infect Dis. Published online December 6, 2013. Abstract


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