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Resident PGY 2
Henry Ford Hospital
HIV preexposure prophylaxis (PrEP) is an effective tool in preventing HIV infection and when taken consistently, reduces HIV transmission via sexual intercourse more than 90% in serodiscordant couples, and more than 70% in intravenous drug users. In United States, men who have sex with men (MSM) remains the highest risk group for HIV transmission accounting for 82% of all newly diagnosed infection. Consistent condom use remains the most effective means to reduce transmission, only 25-28% report using condoms consistently. Rates of HIV transmission in Michigan have been stable at 7.8 per 100,000 people from 2011-2015 while the rates in the Detroit Metro Area remain the highest 37.5 per 100,000 people. In Detroit, a large population of high-risk patients are treated, and there is opportunity to reach these individuals prior to exposure and prevent disease transmission and reduce disease burden. The study aim was to determine provider knowledge, barriers and willingness to prescribe PrEP, in order to guide education initiatives to raise awareness and usage of PrEP therapy. Methods: Anonymous survey was sent to Internal Medicine, Family Medicine and Obstetrics/Gynecology residents and attending physicians at Henry Ford Hospital in Detroit as well as the surrounding community affiliate hospitals. Data was compared using chi-square test for non-sparse data and Fisher exact test for sparse data, with sparsities defined as expected frequencies less than at least 25% of the cells being compared. Data was compared using non-parametric Wilcoxon rank sum test and Kruskal-Wallis test. Results: There was a 33% participation rate amongst those surveyed. Of the 110 respondents 66.4% (73) were internal medicine providers, 25.5 % (28) Ob/gyn, and 8.2% (9) family medicine. Of the participants 55.5% (61) were senior staff and 44.5% (49) residents. 69% of respondents worked at Henry Ford Hospital in Detroit, and 30.9% (34) in surrounding community affiliate hospitals. While 78% (84) of providers had heard about PrEP therapy, only 24% of providers had ever initiated a conversation about PrEP with their patients. 78% indicated that they would prescribe PrEP with more education/training. Comparisons of PrEP knowledge based on provider specialty demonstrated that family medicine physicians were not only more likely to have initiated a discussion (66.7%, 21.9%, 14.3%) about PrEP therapy but also more likely to have prescribed (66.7%, 23.6%, 3.6%) PrEP therapy when compared with Internal Medicine and Ob/Gyn providers. Conclusions: Our survey identified gaps in provider knowledge, comfort level and initiation of discussion with high-risk patients. Providers indicated that with more education/training they would prescribe PrEP. With the data from this survey we will institute educational training for our physicians regarding PrEP therapy in order to improve prescribing rates across our hospital network so as to reach high risk patients and be successful in achieving widespread prescribing.
Scott, Megan; Brar, Indira; Kole, Monica; and Sangha, Roopina, "Provider Knowledge and Comfort with the Use of HIV Pre-exposure Prophylaxis (PrEP) Therapy in High-Risk Patient Populations" (2019). Quality Improvement. 11.