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Question听 What is the association between prescribing clinician specialty and patients not picking up (prescription reversal/abandonment) their initial preexposure prophylaxis (PrEP) prescription?

Findings听 In this cross-sectional study of 37鈥�003 patients who were prescribed PrEP that used claims data, primary care practitioners (PCPs) prescribed to the largest proportion of patients, followed by other specialty clinicians and infectious disease (ID) specialists. Compared with PCPs, patients of ID specialists and other clinicians had lower and higher odds of reversals and abandonments, respectively.

Meaning听 The study results suggest that PCPs are a critical entry point for PrEP care, and non-ID clinicians may especially benefit from greater training, clinical support, and systems for adherence monitoring to enhance PrEP care.

Importance听 Clinicians are a key component of preexposure prophylaxis (PrEP) care. Yet, no prior studies have quantitatively investigated how PrEP adherence differs by clinician specialty.

Objective听 To understand the association between prescribing clinician specialty and patients not picking up (reversal/abandonment) their initial PrEP prescription.

Design, Setting, and Participants听 This cross-sectional study of patients who were 18 years or older used pharmacy claims data from 2015 to 2019 on new insurer-approved PrEP prescriptions that were matched with clinician data from the US National Plan and Provider Enumeration System. Data were analyzed from January to May 2022.

Main Outcomes and Measures听 Clinician specialties included primary care practitioners (PCPs), infectious disease (ID), or other specialties. Reversal was defined as a patient not picking up their insurer-approved initial PrEP prescription. Abandonment was defined as a patient who reversed and still did not pick their prescription within 365 days.

Results听 Of the 37鈥�003 patients, 4439 (12%) were female and 32鈥�564 (88%) were male, and 77% were aged 25 to 54 years. A total of 24鈥�604 (67%) received prescriptions from PCPs, 3571 (10%) from ID specialists, and 8828 (24%) from other specialty clinicians. The prevalence of reversals for patients of PCPs, ID specialists, and other specialty clinicians was 18%, 18%, and 25%, respectively, and for abandonments was 12%, 12%, and 20%, respectively. After adjusting for confounding, logistic regression models showed that, compared with patients who were prescribed PrEP by a PCP, patients prescribed PrEP by ID specialists had 10% lower odds of reversals (odds ratio [OR], 0.90; 95% CI, 0.81-0.99) and 12% lower odds of abandonment (OR, 0.88; 95% CI, 0.78-0.98), while patients prescribed by other clinicians had 33% higher odds of reversals (OR, 1.33; 95% CI, 1.25-1.41) and 54% higher odds of abandonment (OR, 1.54; 95% CI, 1.44-1.65).

Conclusion听 The results of this cross-sectional study suggest that PCPs do most of the new PrEP prescribing and are a critical entry point for patients. PrEP adherence differs by clinician specialties, likely due to the populations served by them. Future studies to test interventions that provide adherence support and education are needed.