Preexposure Prophylaxis Provided in the Emergency Department: Clinician Perspectives.

Abstract

Objectives: The southern United States is facing a burden of human immunodeficiency virus (HIV) diagnoses, with 52% of new diagnoses made in the region. The emergency department (ED) is an important access point for patient care, especially given nationwide shortages in primary care appointments. The objective of our study was to assess ED (ED) clinician knowledge regarding preexposure prophylaxis (PrEP), the perceived barriers to initiation of PrEP, and clinician willingness to initiate it in the ED.

Methods: An institutional review board-approved survey was distributed using an internal e-mail listserv to all ED physicians and advanced practice clinicians within a southern academic level I trauma center ED. The survey was available throughout August 2023. Descriptive statistics described survey responses.

Results: Fifty-six Emergency Medicine clinicians participated, for a response rate of 25.0%. Nearly one-fourth of clinicians reported not prescribing PrEP because they believed they lacked knowledge of or familiarity with the medication. Whereas 52 believed that PrEP could be integrated in the ED, 54 mentioned a potential barrier to implementation. The most common barrier to integrating PrEP into the ED was lack of information/training; additional barriers included time and staff constraints. More than half expressed a lack of confidence (58.9%) assessing PrEP eligibility. When asked how likely they would be to discuss linkage to PrEP, 52.8% answered confident or very confident and 52.8% were not confident or slightly not confident.

Conclusions: Despite recognition of the utility of prescribing PrEP in the ED, clinicians identified multiple barriers to providing this essential component of health care. Findings indicate, however, that Emergency Medicine clinicians would be willing to prescribe PrEP with appropriate education and connection to care.