Faculty Collaboration Database

Factors Related to Pre-exposure Prophylaxis Prescription by U.S. Primary Care Physicians. Am J Prev Med 2017 Jun;52(6):e165-e172

Date

04/02/2017

Pubmed ID

28363410

Pubmed Central ID

PMC5438776

DOI

10.1016/j.amepre.2017.01.025

Scopus ID

2-s2.0-85016829551 (requires institutional sign-in at Scopus site)   45 Citations

Abstract

INTRODUCTION: Although pre-exposure prophylaxis (PrEP) greatly reduces risk of HIV infection in HIV-negative individuals, use is not widespread enough to impact HIV incidence. Involvement of primary care physicians (PCPs) in PrEP prescription is essential, but previous research has shown low rates of prescription among PCPs. To identify targets for interventions, the information-motivation-behavioral skills model for PrEP discussion and prescription was tested in a ten-city sample of PCPs.

METHODS: PCPs from ZIP codes with high HIV incidence in ten U.S. cities (N=280, 52% male, 56% white) completed a survey online between July 2014 and May 2015. Information items assessed knowledge, motivation items evaluated attitudes, and behavioral skills items measured comfort with behaviors involved in prescribing PrEP. Providers indicated whether they had discussed PrEP with or prescribed PrEP to patients. Data were analyzed in 2015 and 2016.

RESULTS: One third of PCPs had discussed and 17% had prescribed PrEP. A structural equation model with good fit supported the information-motivation-behavioral skills model. Information and motivation predicted behavioral skills (b=0.35, 95% CI=0.13, 0.57; and b=0.31, 95% CI=0.14, 0.47, respectively). Behavioral skills predicted prescription (b=0.27, 95% CI=0.12, 0.42). Furthermore, behavioral skills mediated effects of information and motivation on prescription (b=0.10, 95% CI=0.03, 0.19; and b=0.08, 95% CI=0.03, 0.16, respectively).

CONCLUSIONS: The information-motivation-behavioral skills model can be applied to PCPs' PrEP discussion and prescription. Its constructs represent potential targets for PCP-directed interventions to increase PrEP use in high-risk populations.

Author List

Walsh JL, Petroll AE

Authors

Andrew Petroll MD Professor in the Medicine department at Medical College of Wisconsin
Jennifer L. Walsh PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-HIV Agents
Female
HIV Infections
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Physicians, Primary Care
Practice Patterns, Physicians'
Pre-Exposure Prophylaxis
Surveys and Questionnaires
United States