HIV PrEP Knowledge and Prescribing Patterns Among Healthcare Providers in Southwestern Pennsylvania.

Abstract

Background: Despite the proven effectiveness of HIV PrEP, uptake remains suboptimal, and provider-level barriers have been shown to impede implementation. Southwestern Pennsylvania, including Allegheny County, has a high HIV burden, yet limited data exist on regional provider knowledge, comfort, and prescribing practices. This study surveyed healthcare providers across different specialties to identify gaps and modifiable barriers influencing PrEP uptake.

Methods: A cross-sectional survey was distributed to healthcare providers across the University of Pittsburgh Medical Center from September 2025 to January 2026. The 29-item survey assessed self-assessment of PrEP knowledge, prescribing comfort, likelihood of future prescribing, perceived barriers and facilitators, and provider demographics.

Results: Two hundred and sixty-seven healthcare providers completed the survey (9.3% response rate). Only 104 (38.9%) providers reported good or better PrEP knowledge, with substantially lower rates for PrEP side effects and monitoring requirements. Based on self-assessment, physicians had significantly higher odds of PrEP knowledge (odds ratio [OR] [95% confidence intervals (CI)] = 4.37 [2.27-8.59]), prescribing comfort (OR [95% CI] = 5.84 [2.52-13.51]), and prescribing likelihood (OR [95% CI] = 4.30 [1.66-11.15]) compared with advanced practice providers. Pediatric, obstetrics-gynecology, and emergency medicine providers had significantly lower prescribing likelihood compared with family medicine. The most cited structural barriers were lack of provider training (71.3%) and insufficient clinic protocols (63.3%).

Conclusions: Significant specialty-specific disparities in PrEP knowledge and prescribing readiness persist. Enhancing provider education, clinical protocols, and structural supports may improve PrEP implementation and strengthen regional HIV prevention efforts.