Examining Provider Attitudes and Barriers toward Prescribing PrEP within Primary Care Settings in Alabama

Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is an effective HIV prevention tool. Expanding PrEP access and utilization is made possible by incorporating it into primary care practice. This study explored the barriers in and attitudes toward prescribing PrEP to adults among primary care providers (PCPs) in Alabama, a priority HIV jurisdiction with low PrEP uptake.

We conducted in-depth interviews grounded in the Health Belief Model with Alabama physicians and advanced practice practitioners in general internal and family medicine, exploring provider experiences in collecting sexual history information from patients and prescribing PrEP. Authors used thematic analysis of transcripts to further investigate the emerging themes.

From September 2022 to April 2023, eight PCPs participated in our study. Several themes regarding barriers in and attitudes toward discussing sexual health history emerged: time constraints, knowledge and training, comfort levels, and competing priorities. We identified stigma and knowledge as themes when exploring provider attitudes toward and barriers in prescribing PrEP. When discussing the benefit of PrEP provision in primary care, we also identified themes such as longevity of the patient-provider relationship and accessibility. Participants identified multiple opportunities to increase PrEP provision in primary care beyond provider education and training, such as normalizing the language, consistency in discussing sexual health history, and using streamlined efforts of gathering sexual history information.

With barriers hindering PrEP prescribing by Alabama's PCPs, in addition to preexisting healthcare barriers experienced by patients in the US Deep South, immediate attention is warranted. Further exploration into developing policies for streamlining sexual history intake and inclusive medical education and training regarding PrEP is needed in Alabama.