The most common prescriber of preexposure prophylaxis (PrEP) for HIV is primary care physicians, according to recent data from a Medicare database published as a Research Letter in JAMA.
“These results suggest that public health efforts to increase access to PrEP are needed, such as enhancing clinician education to identify appropriate candidates,” Hyun Jin Song, MPharm, PhD, of the Department of Pharmaceutical Outcomes and Policy at University of Florida College of Pharmacy in Gainesville, Florida, and colleagues wrote.
Although the US Preventive Services Task Force has recommended PrEP as a way to reduce HIV infection in at-risk populations, about 7% of individuals used PrEP in 2016, according to a Morbidity and Mortality Weekly Report from the CDC. “Clinicians have been slow to prescribe PrEP, citing concerns regarding its effectiveness outside a clinical trial setting, unintended consequences, and ambiguity surrounding which type of clinician is best suited to prescribe PrEP,” Dr. Song and colleagues said.
To assess prescriptions and use of PrEP, the researchers used the MarketScan Commercial and Medicare Supplemental database, identifying 47,132 individuals (397,913 prescriptions) who used PrEP for at least 30 days between 2012 and 2018. PrEP was defined as tenofovir-disoproxil-fumarate with emtricitabine (TDF/FTC), and the researchers excluded individuals who also had drug treatments for HIV and hepatitis B virus within a year of the prescription to eliminate the possibility of TDF/FTC being indicated for treatment of those diseases. Dr. Song and colleagues also analyzed specialty information, evaluating which HIV care and non–HIV care physicians were prescribing PrEP over the study period.
The results showed a significant increase in individuals prescribed PrEP between 2012 (821 people; 0.13 per 10,000 beneficiaries) and 2018 (29,799 individuals; 10.56 per 10,000 beneficiaries), while PrEP prescriptions significantly increased from 2012 (203 prescriptions) to 2018 (9,223 prescriptions) (both P < .001). Overall, 96% of recipients were men and 73% were between 18 years and 44 years old.
In 16,193 individuals who were linked to physician specialty information, the researchers found 79% of PrEP prescriptions were attributed to primary care physicians, and 7% of prescriptions were attributed to infectious disease physicians. Within the subset of physicians prescribing PrEP, 42% of HIV care physicians were responsible for 64% of PrEP prescriptions, and within primary care physicians, HIV care primary care physicians were responsible for 53% of PrEP prescriptions.
The researchers acknowledged missing data within the study, including a range of 34% to 38% of missing data for physician specialty. The study also excluded 56% of data that constituted refills of prescriptions.
“The numbers of PrEP prescriptions prescribed by physicians may be underestimated due to missing physician information or inability to match to a physician. This study included commercially insured persons only, so results may not be generalizable to other populations” such as Medicaid, the researchers said.