Rural providers' attitudes toward integrating harm reduction strategies and PrEP prescribing into rural primary care settings in the US. Southeast and Midwest

People with opioid use disorders (OUD) living in the South and Midwest are under-prescribed pre-exposure prophylaxis (PrEP) despite an increasing number of providers writing PrEP prescriptions in other regions of the United States. Greater research is needed into attitudes toward integrating harm reduction strategies into primary care and PrEP prescribing among prescribers working in rural primary care settings. The objective of this paper was to examine relationships between providers' attitudes toward buprenorphine and methadone, comprehensive harm reduction (e.g., fentanyl test strips) and self-reported PrEP prescribing in the past year.

Relationships were examined between attitudes toward buprenorphine and harm reduction services, and PrEP prescribing among 409 rural primary health care providers (PCPs) treating at least one person with OUD or HIV in several EHE priority states. A Qualtrics panel survey was administered to primary care providers residing in the U.S. South and Midwest and worked in a Federally Qualified Health Center, Rural Health Clinic or other HRSA-eligible health center. Chi-square tests were used to explore significant differences between PrEP prescribers and non-Prescribers on attitudes toward integrating MOUD, drug-related harm reduction into primary care.

Overall, 62.1% (n = 254) of the sample of providers reported writing at least one prescription for PrEP in the past year. Providers who believed that reforming buprenorphine waiver laws made their jobs easier or who expressed interest in integrating naloxone distribution and syringe exchange into primary care were more likely to write prescriptions for PrEP compared to providers who did not have these beliefs. Providers who were from larger facilities and who had specialty training in infectious diseases were more likely to write prescriptions for PrEP.

Findings from this study suggest that providers who are more open to integrating harm reduction services into primary care are more likely to prescribe PrEP in the past year. PCPs with more positive attitudes toward naloxone, syringe exchange, and buprenorphine were more likely to prescribe PrEP in the past year. Combination interventions may be a promising avenue of reducing the harms of drug use including overdose and HIV infection among populations of people who use drugs.