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J Gen Intern Med. 2017 Jan;32(1):62-70. doi: 10.1007/s11606-016-3903-z. Epub 2016 Oct 24.

A Cross-Sectional Online Survey of HIV Pre-Exposure Prophylaxis Adoption Among Primary Care Physicians.

Author information

Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
Yale University School of Medicine, New Haven, CT, USA.
Johns Hopkins University, Baltimore, MD, USA.
Yale University School of Public Health, New Haven, CT, USA.
Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
NIDA-Intramural Research Program, NIH, Baltimore, MD, USA.
University of Illinois-Chicago, Chicago, IL, USA.



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.


HIV prevention; implementation; pre-exposure prophylaxis; primary care physicians

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Compliance with Ethical Standards Funders This work was generously supported by Yale Center for Clinical Investigation (UL1 TR000142). E. Jennifer Edelman was funded as a Yale Drug Abuse, Addiction and HIV Research Scholar (DAHRS) during the writing of this manuscript (K12DA033312-03). Oni Blackstock is supported by K23MH102129 and Dr. Sarah Calabrese by K01MH103080. Conflict of Interest The authors declare that they do not have a conflict of interest.

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