Psychiatrists' Experiences, Training Needs, and Preferences Regarding Prescription and Management of HIV Pre-exposure Prophylaxis (PrEP) Within Psychiatric Care

Background: People living with mental illness (PLWMI) experience a disproportionate prevalence and incidence of HIV. Preventing HIV among PLWMI is a priority for multiple domestic public health agencies. As key clinicians for this group, psychiatrists may have an important role to play in increasing PrEP use among PLWMI.

Methods: A national survey of psychiatrists (N = 880) about integrating PrEP prescription into psychiatric practice was conducted between November 2022-October 2023. Specifically, we inquired about experiences with PrEP prescription, patient request for PrEP, and interest in prescribing PrEP. We also inquired about barriers to PrEP prescription in psychiatry and preferred models for implementing PrEP prescription in psychiatry.

Results: We found that 19.3% of psychiatrists had received a request for PrEP from a patient, 17.3% had prescribed, and 53.9% were interested in prescribing. The greatest percentage of psychiatrists who prescribed PrEP were practicing primarily in inpatient psychiatry (28.8%). Practicing in one of the federal Ending the HIV Epidemic (EHE) priority jurisdictions (aOR = 2.08 [1.23–3.54], p = 0.003) and greater self-confidence in PrEP-related tasks (aOR = 2.10 [1.67–2.65], p < 0.001) were associated with higher likelihood of PrEP prescription. Limited knowledge of PrEP was the barrier endorsed by the greatest percentage of psychiatrists (76.3%). Most preferred a hypothetical model in which a psychiatrist prescribed an initial course of PrEP with prompt primary care or infectious disease follow-up (63.1%).

Conclusion: Most psychiatrists were interested in prescribing PrEP. Training is needed to enable PrEP implementation in psychiatric practice including development of collaborative practice models to engage psychiatrists across a diversity of settings.

Highlights

• HIV incidence among psychiatric patients is higher than the general population and uptake of highly-effective HIV pre-exposure prophylaxis (PrEP) is poorly understood among this group
• Psychiatrists are main points of contact and may serve to increase access to PrEP
• We found a low percentage of psychiatrists had previously prescribed PrEP, but were overall interested in PrEP prescribing with appropriate training
• The most frequently encountered barrier to PrEP prescribing was limited knowledge which can be overcome with standardized training
• Implementation science, system innovation, and collaboration will be needed in order to support PrEP prescription within psychiatric practice