Prescribing pre-exposure prophylaxis (PrEP) for HIV prevention: A cross-sectional survey of General Practitioners in Australia

Background Pre-exposure prophylaxis (PrEP) is a safe and effective medication for preventing HIV acquisition. We examined Australian general practitioners (GP) knowledge of PrEP efficacy, characteristics associated with ever prescribing PrEP, and barriers to prescribing. Methods We conducted an online cross-sectional survey of GPs working in Australia between April and October 2022. We performed univariable and multivariable logistic regression analyses to identify factors associated with: 1) the belief that PrEP was at least 80% efficacious; and 2) ever prescribed PrEP. We asked participants to rate the extent to which barriers affected their prescribing of PrEP. Results 407 participants with a median age of 38 years (interquartile range 33-44). Half of the participants (50%, 205/407) identified how to correctly take PrEP, 63% (258/407) had ever prescribed PrEP, and 45% (184/407) felt confident with prescribing PrEP. Ever prescribing PrEP was associated with younger age (AOR 0.97, 95%CI: 0.94-0.99), extra training in sexual health (AOR 2.57, 95%CI: 1.54-4.29), and being a S100 Prescriber (OR 2.95, 95%CI: 1.47-5.90). The main barriers to prescribing PrEP included: Difficulty identifying clients who require PrEP/relying on clients to ask for PrEP (76%, 310/407), Lack of knowledge about PrEP (70%, 286/407), and Lack of time (69%, 281/407). Conclusion Less than half of our GP respondents were confident in prescribing PrEP, and most had difficulty identifying who would require PrEP. Specific training on PrEP, which focuses on PrEP knowledge, identifying suitable clients, and making it time efficient is recommended, with GPs being remunerated for their time. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement DG is supported by a Canada Research Chair in Sexual and Gender Minority Health. EPFC and JJO are each supported by an NHMRC Emerging Leadership Investigator Grant (GNT1172873 and GNT1193955, respectively). CKF is supported by an Australian NHMRC Leadership Investigator Grant (GNT1172900). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Alfred Ethics Committee of Alfred Health, Melbourne, Australia gave ethical approval for this work (166/22). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes JO, EC and JW had full access to all of the data in the study. De-identified data is available on reasonable request to the corresponding author.