Reluctance to Prescribe Pre-Exposure Prophylaxis (PrEP) Among Internal Medicine Residents (IMRs) Training at a U.S. Hospital with a Large HIV-infected Population

BACKGROUND: PrEP is effective in HIV prevention, though access to PrEP in the US has been concentrated in HIV/STI healthcare settings. We examined IMRs’ willingness to prescribe PrEP in an urban hospital in Chicago associated with a large HIV outpatient center. METHODS: IMRs were anonymously surveyed regarding their knowledge and likelihood of prescribing PrEP stratified by patient risk behaviors and their own attitudes and perceptions. Bivariate analysis was performed, and p-values with α <0.05 for significance were calculated for comparisons by IMRs who had rotated on a dedicated HIV inpatient service, by level of training (PGY-1 vs. >PGY-2), and between planning on specializing in primary care (PC), infectious disease (ID) vs. other specialties. RESULTS: Most 86/120 (71%) of IMRs completed the survey and 30/86 (35%) had completed an inpatient HIV service rotation. The majority (88.4%) believed it is “very important” to universally screen patients for HIV, and most (72.1%) said they were “comfortable” or “very comfortable” taking a sexual history. Very few (2.3%) had ever prescribed PrEP, though only 3.5% reported requests for PreP in their practice, and 44.2% would be “unlikely” or “somewhat unlikely” to prescribe PrEP to patients if requested. IMRs with HIV service experience correctly identified the number of pills in PrEP compared with IMRs with no experience (47.0% vs 18.9%, P = 0.01). IMRs planning on other specialties were more likely to rank knowledge of PrEP as “not familiar” when compared with IMRs entering PC and ID, (21.0% vs. 0%, P = 0.02). The most common barriers to prescribing PrEP were lack of familiarity, lack of program guidance, cost, and unclear risk to benefit ratios (75.6%, 41.9%, 29.1%, 26.7%, respectively). CONCLUSION: While recognizing that HIV testing is important, IMRs surveyed displayed a lack of knowledge of PrEP, most likely due to limited exposure in their medical education/training. Rotations on an HIV service appeared to increase PrEP knowledge as did planned entry into PC or ID. In order to increase PrEP knowledge and usage, enhanced PrEP education, and importantly exposure to high-risk patients should be incorporated into the curriculum of evidence-based prevention interventions during IMR training. DISCLOSURES: All authors: No reported disclosures.