Background: The Bronx has the highest rate of people living with HIV among New York City boroughs, with South Bronx zip codes exceeding the statewide average by over four times. Despite this, pre-exposure prophylaxis (PrEP) utilization in the Bronx significantly lags, with a PrEP-to-need ratio over nine times lower than Manhattan’s and four times lower than Brooklyn’s. This study aims to address the gaps in PrEP prescription by exploring healthcare providers’ perspectives at Lincoln Hospital, a safety-net hospital in the South Bronx.
Methods: From January 2024 to July 2024, anonymous surveys using Survey Monkey were distributed among healthcare providers in the ambulatory clinic at Lincoln Hospital. The questions covered provider demographics, knowledge, attitudes, perceptions, and experience with PrEP. The final sample included 91 providers: 19 attending physicians and 72 residents. Data were analyzed using SPSS statistical software, and Pearson’s Chi-square test was used to assess statistically significant differences between variables. Binary logistic regression was used to calculate odds ratios for selected associations. Subgroup analysis was conducted to compare the survey responses between prescribing and nonprescribing providers and between resident and attending providers.
Results: In our sample of providers, 29 (32%) had previously prescribed PrEP, while 62 (68%) had not. Insufficient education on PrEP was the primary concern amongst non-prescribing providers (71%). They had more concerns about the challenges associated with PrEP use, including riskier sexual behaviors (31%), medication non-compliance (24%), and cost/insurance issues (62%). Physicians were more likely to prescribe PrEP when patients actively inquired about it (OR=16.88), with attending physicians more willing to prescribe PrEP than residents (74% vs. 21%). Providers were also surveyed on what measures would help encourage PrEP prescription. Non-prescribers cited greater training and education (84%) and the establishment of a protocol (58%) the most, while prescribers chose the presence of a protocol (59%) and pharmacy support for insurance coverage (55%) the most. Self-reported knowledge among residents notably increased the odds of PrEP prescription. Of three questions assessing actual knowledge of PrEP, only the ability to correctly identify PrEP medications correlated with prescription behavior. Using a multivariate regression analysis, education on PrEP was shown to predict prescription irrespective of actual knowledge.
Conclusions: Our analysis shows that providers’ perceived knowledge of PrEP had a greater impact on prescription behavior than their actual knowledge. Education was found to boost confidence in prescribing PrEP, even among those with limited knowledge. Differences in perceptions of PrEP between prescribing and non-prescribing providers highlight the need to address misconceptions. Overall, our findings underscore the need for better patient-provider communication and targeted education to increase PrEP prescription.