Conversations Around HIV PrEP With Adolescents Vary Between Urban, Rural Family Physicians

Family medicine physicians in rural areas were less comfortable providing sexual risk reduction counseling to adolescents compared with physicians in urban areas, including conversations around HIV and pre-exposure prophylaxis (PrEP).

These findings were published in The Journal of Rural Health.

This is the first study to compare PrEP health care practices between rural and urban family medicine physicians, noted Christopher Owens, PhD, MPH, study author and assistant professor at Texas A&M University School of Public Health.

“With HIV rates in rural areas increasing among adolescents and the lack of PrEP and adolescent medicine providers in rural areas, rural PCPs [primary care providers] are frontliner providers in providing sexual health care and PrEP health care in their communities,” Owens said.

A total of 256 US family medicine physicians were recruited from a Qualtrics panel and completed an online cross-sectional survey between July 15 and August 9, 2022. Participating physicians ranked their comfort with performing 9 PrEP-related clinical activities on a scale of 1 (completely uncomfortable) to 5 (completely comfortable).

Of this group, most were assigned male at birth (66.4%), cisgender (98.4%), and heterosexual (91.8%). Most (66%) physicians were non-Hispanic White (66.0%), and Owens noted physicians practicing in urban areas who responded to the survey were more racially diverse compared with rural areas (χ2 = 17.02; P = .017).

About 70% and 30% of respondents practiced in urban and rural areas, respectively. Owens noted this difference may skew the results, with selection bias being another potential limitation.

“However, the proportion of rural family medicine physicians in our study (29.3%) is close to the proportion of family medicine physicians who practice in rural areas in the IUnited States (22.5%),” he added.

Specifically for adolescent care, the survey revealed rural family medicine physicians were less comfortable than urban family medicine physicians in providing sexual risk reduction counseling, telling a patient their HIV test result was positive, and implementing all PrEP clinical activities.

Most respondents said they went over sexual history with an adolescent patient (94.5%), ordered or recommended an HIV test (89.8%) or sexually transmitted infection test (95.3%) to an adolescent patient, and heard of HIV PrEP (95.7%). Trends were similar between urban and rural physicians. However, 62.4% and 64% of respondents from urban and rural areas, respectively, said they have not prescribed PrEP to an adolescent.

Regarding comfort performing the PrEP-related clinical activities, the most statistically significant differences between urban and rural family medicine physicians were in overall comfort and providing sexual risk reduction counseling.

Rural respondents had a lower likelihood of being overall comfortable than urban respondents (odds ratio [OR], 0.48; 95% CI, 0.25-0.92; P = .027) and providing sexual risk counseling (OR, 0.34; 95% CI, 0.14-0.86; P = .022).

Rural physicians were also less comfortable in telling an adolescent their test result was positive for HIV (OR, 0.44; 95% CI, 0.23-0.85; P = .014). Overall, 89.1% of physicians were comfortable ordering an acute HIV test for an adolescent patient, but only 32.4% were comfortable telling an adolescent patient their test result was positive.

Additionally, physicians who identified as conservative had a 54% lower likelihood of being overall comfortable prescribing PrEP to an adolescent compared with physicians who identified as liberal (OR, 0.46; 95% CI, 0.23-0.91; P = .025).

“With PrEP providers and pediatric/adolescent medicine providers being less likely to be located in rural areas, family medicine providers need to be comfortable implementing the PrEP guidelines in their communities,” Owens said. “Patient navigators, routine and computerized sexual history forms, guidelines being in electronic medical records, and patient-provider communication scripts could increase rural PCPs’ knowledge and comfort about implementing the PrEP guidelines.”

According to Owens, further research is needed to better understand the factors of rural family medicine physicians in implementing PrEP guidelines for adolescent patients.

Reference

Owens C. HIV pre-exposure prophylaxis awareness, practices, and comfort among urban and rural family medicine physicians. J Rural Health. Published online November 7, 2022. doi:10.1111/jrh.12723