Pre- and post-exposure prophylaxis (PrEP and PEP) for HIV are effective yet under-prescribed. The New York City (NYC) Health Department conducted a public health detailing campaign October 2014-April 2015. Representatives visited primary care (PC) and infectious disease (ID) providers to promote prescribing PrEP and PEP, focusing on practices that had recently diagnosed HIV among at-risk populations. Initial and follow-up visits (~5-8 weeks later) consisted of short, individual-level presentations. We examined characteristics associated with PrEP prescribing at initial visit (early adopter) and with prescribing at follow-up visit (incident prescriber).
We included potential prescribers [MDs, nurse practitioners (NPs), and physician assistants (PAs)] reached for both initial and follow-up visits. Providers were identified as early adopters or incident prescribers based on self-report of ever prescribing PrEP at initial or at follow-up only, respectively. Characteristics examined were provider specialty/training [PC-MD, ID-MD or NP/PA]; practice characteristics, including type [hospital-affiliated (HA), private practice (PP), community health clinic (CHC)]; location (Manhattan vs. other); neighborhood HIV diagnosis and poverty rates; report of prescribing post-exposure prophylaxis (PEP); and length of initial visit (min). Multivariate models were constructed using generalized estimating equations. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported with all characteristics adjusted for each other except PEP; PEP was adjusted for all others.
At initial visit, 18% (155/881) of providers at 492 facilities were early adopters. Among all others, 13% (89/709) of providers at 412 facilities reported incident prescribing. Early adoption was associated with ID-MD (Table); CHC practice type vs. PP (aOR 1.9, CI 1.1-3.2) and vs. HA (aOR 2.5 CI 1.4-4.5); Manhattan location (aOR 4.2 CI 2.5- 7.2); and PEP prescribing (Table). Incident prescribing was associated with ID-MD; previous and incident PEP prescribing; and initial visit length ≥10 min, with no additional increase seen ≥20 (Table).
We observed early adoption and incident PrEP prescribing at NYC practices serving at-risk and potentially low-income populations. Prescribing PEP may be an important step for newly prescribing PrEP, supporting the promotion of PrEP and PEP in tandem. Detailing may have influenced new PrEP prescribing, particularly if the initial presentation was ≥10 min.