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Insufficient PrEParation: an assessment of primary care prescribing habits and use of pre-exposure prophylaxis in patients at risk of HIV acquisition at a single medical centre
  1. Jane Babiarz1,
  2. Chad D Nix2,
  3. Sean Bowden3,
  4. Rachel Roberts4
  1. 1 Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  2. 2 School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  3. 3 School of Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
  4. 4 Business Intelligence and Advanced Analytics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Jane Babiarz, Internal Medicine, Oregon Health & Science University Department of Medicine, Portland, OR 97239, USA; babiarz{at}


Objectives To assess HIV pre-exposure prophylaxis (PrEP) prescribing habits by primary care providers and the number of patients at risk of HIV acquisition at a single medical centre in the Northwestern USA from 1 July 2018 to 31 June 2020.

Methods An electronic cross-sectional survey was administered in April and May 2021 to providers in family medicine, internal medicine, adolescent and young adult health, student health and women’s health clinics affiliated with the medical centre with questions pertaining to PrEP prescribing practices. Electronic medical record abstraction was used to quantify the number of eligible patients who sought care in primary care departments and the adherence to PrEP initiation guidelines from 1 July 2018 to 31 June 2020.

Results 74% (61/82) of providers reported familiarity with national clinical practice guidelines for the prevention of HIV infection. 50% (41/82) of respondents were located in family medicine clinics. 57% (47/82) of providers counseled less than one-quarter of those who they identified as at risk of HIV infection. The major barriers to prescribing PrEP were insufficient time and lack of familiarity with guidelines. Of the 4330 eligible patients for PrEP, 8% (337/4330) received at least one PrEP prescription during the study period. For patients newly prescribed PrEP, only 23% (39/170) had appropriate counseling and labs at initiation. The top three qualifying indications for PrEP were identifying as transgender (36%, n=1562), high-risk sexual behaviour (32%, n=1405) and injection drug use (30%, n=1289).

Conclusions This study highlights intervention points in the HIV prevention cascade warranting attention in order to achieve the 2025 Ending the HIV Epidemic in the U.S. target for PrEP coverage. These include increasing provider adherence to prescribing guidelines and reducing the logistical barriers to prescribing.

  • Communicable Diseases
  • HIV
  • Pre-Exposure Prophylaxis
  • Program Evaluation

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  • Handling editor Ming Jie Lee

  • Contributors JB is responsible for the overall content as guarantor. CDN contributed substantially to the conception, design, analysis, interpretation of the data and manuscript writing. SB contributed to the conception, design, analysis and interpretation of the data included. RR contributed to data extraction.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.