Table 2.

Summary of Patient and Provider Acceptance Studies^11-28

Study	Population	N	Acceptance	Barriers
Patients
Hoff et al11	MSM Serodiscordant (HIV+/HIV−) and seroconcordant (HIV−/HIV−)couples	171	57% HIV− men in serodiscordant and 46% HIV− men in seroconcordant relationships indicated PrEP would be a good prevention strategy for themselves	Not reported
Rolle et al12	MSM African American 16-29 years of age	184	64% expressed interest in PrEP 34% were prescribed PrEP 20% initiated PrEP	Of those who did not initiate PrEP, the following reasons were reported: consistent condom use, worried about side effects, lack of social support, and would be unhappy taking a pill every day
Mayer et al13	MSM	4698	17% had used PrEP	22% were unaware of PrEP 85% had never used PrEP due to concerns of cost (40%), side effects (31%), effects in insurance (20%), and not feeling at risk (19%)
Restar et al14	Young Transgender Women (16-29 years)	230	66% expressed interest in PrEP when told about it Acceptability of PrEP was associated with PrEP interest and having a medical provider who met health needs	68% were unaware of PrEP Most common reasons for disinterest in PrEP: Concern for side effects (21%) Mistrust of providers and researchers (17%)
Park et al15	Women on PrEP Most in known serodiscordant relationships	12	Reported PrEP allowed them to remain healthy, improve intimacy with their partners, and reduce anxiety of potentially being infected with HIV	Most reported PrEP-related stigma and did not disclose PrEP use to others
Koren et al16	Women	389	57% willing to take PrEP 64% felt comfortable discussing PrEP with their doctor	73% had never heard of PrEP Concerns of cost (44%) and side effects (39%)
Blumenthal et al17	Women	18	Most said they would be interested in initiating PrEP as part of a PrEP demonstration project	Expressed limited knowledge of PrEP Concerns for side effects, resistance, misuse, effects on pregnancy, stigma, and long term effects Identified competing priorities, lack of partner support, and judgement from providers as barriers
Shrestha et al18	IVDUs	20	Most would be interested in trying PrEP. Those not interested in PrEP stated that they did not engage in risky behaviors, but would be interested if they did engage in risky behaviors in the future.	95% had never heard of PrEP Concerns of risky behaviors, cost, side effects, drug interactions with methadone, burden of daily medication, and stigma were expressed
Kuo et al19	IVDUs and heterosexuals	942	Not reported	87% of heterosexuals had never heard of PrEP <1% had taken PrEP 91% of IVDUs had never heard of PrEP None had taken PrEP
Providers
Okoro et al20	Community pharmacists in Minnesota	347	33% had dispensed	Primary concerns with PrEP implementation were identifying appropriate candidates (20%), patient adherence (16%), and cost (15%) 26% reported they would be comfortable counseling about PrEP; most discomfort was regarding knowledge about medication (32%) and behavior modification (20%)
Shaeer et al21	Florida pharmacists	225	22% had dispensed	47% were uncomfortable counseling about PrEP and 71% felt they did not have sufficient knowledge about PrEP to counsel
Unni et al22	Community pharmacists in Utah	251	Not reported	Actual knowledge of PrEP was higher than self-perceived knowledge. 20% agreed they were capable of counseling about PrEP; was correlated with education level (PharmD vs Bachelor) and years of experience
Karris et al23	Infectious Diseases Physicians	573	9% had prescribed	14% reported they would not provide PrEP based on concerns for drug resistance (77%), providing potentially toxic drugs to healthy individuals (53%), and lack of evidence in real-world settings (53%)
Blumenthal et al24	Physicians, nurse practitioners, nurses, social workers, and medical students attending infectious diseases conferences in New Year, San Diego, and Los Angeles	233 (including 201 prescribers)	21% had prescribed	35% thought HIV providers should prescribe PrEP, 31% non-HIV providers, 21% public health departments (21%), and 10% STI clinics Greater than 40% of participants reported drug toxicities, potential resistance, and adherence issues may limit their willingness to prescribe PrEP
Rapeephan et al25	Physicians, PA, registered nurses, medical students, medical assistant, research coordinator, PA student at Tufts Medical Center in Boston, MA	80 (including 61 prescribers)	15% had prescribed 75% would refer patients to infectious diseases specialist for PrEP	Prescribers indicated discomfort with prescribing PrEP due to not enough knowledge (73%), lack of experience (56%), and not covered by insurance (18%)
Tortelli et al26	Emergency physicians at Washington University in St. Louis, MS	88	94% were interested in receiving training on PrEP	24% were knowledgeable of current guidelines 23% were knowledgeable of referral information Major concerns included lack of efficacy (54%), side effects (90%), and resistance (70%)
Zhang et al27	Local health departments in North Carolina	56	4% had prescribed 7 (13%) had referred patients for PrEP services	The majority of reasons cited by the health departments for not providing PrEP were related to lack of resources and training
Shrestha et al18	Infectious diseases nurses, addictions counselors, HIV prevention counselor, physicians, and an administrator treating IVDUs	10	Not reported	Only one had read the CDC guidelines for PrEP use Concerns expressed included, patient acceptability, cost, increase in STIs, adherence, side effects, stigma, and administrative logistics
Petroll et al28	PCPs and HIV providers (physicians, NPs, and PAs)	525	17% PCPs had prescribed 64% HIV providers had prescribed	28% PCPs felt familiar with PrEP (vs. 76% HIV providers) PCPs identified limited knowledge and concerns about insurance coverage as barriers

CDC = centers for disease control and prevention, HIV = human immunodeficiency virus, IVDUs = Intravenous Drug Users, MSM = men who have sex with men, NP = nurse practitioner, PA = physician assistant, PCP = primary care provider, PrEP = pre-exposure prophylaxis, STI = sexually transmitted infection