Pre-exposure prophylaxis (PREP) guideline awareness and prescribing behaviors among healthcare providers in the United States

Abstract

INTRODUCTION: Pre-exposure prophylaxis (PrEP) prescription rates in the U.S. remain suboptimal despite its high efficacy in HIV prevention. Healthcare provider (HCP) awareness of PrEP guidelines is crucial, yet limited data exist on guideline-specific awareness versus general PrEP knowledge. This study examined PrEP guideline awareness, prescribing behaviors, and associated HCP characteristics using 2022-2024 DocStyles data to inform targeted interventions.

METHODS: Data were drawn from the 2022-2024 DocStyles surveys of U.S. HCPs (N = 4,507). Chi-square tests and generalized linear models assessed relationships between PrEP guideline awareness, prescribing behaviors, and HCP demographic and clinical characteristics.

RESULTS: PrEP guideline awareness increased from 44% (2022) to 57% (2023), then declined to 50% (2024; p <.001). HCPs over age 44 and OB/GYNs were more likely to be aware of PrEP guidelines than younger HCPs and family practitioners. Guideline awareness did not differ by region, sex, race/ethnicity, or clinical setting. PrEP prescribing to all sexually active individuals increased from 23% (2022), 29% (2023) to 33% (2024; p <.001). Non-White HCPs were more likely to prescribe PrEP than White HCPs. Compared to HCPs in the South, those in the Northeast and West were more likely to prescribe PrEP, while Midwestern HCPs were less likely. OB/GYNs, NPs, and PAs were less likely to prescribe PrEP than family practitioners.

CONCLUSION: Significant variations in PrEP guideline awareness and prescribing behaviors exist among U.S. HCPs. Targeted communication campaigns and tailored interventions are essential to address these differences, enhance guideline adherence, and optimize PrEP uptake to reduce HIV incidence nationally.