Building Clinician Confidence to Prescribe HIV PrEP in Primary Care

"Building Clinician Confidence to Prescribe HIV PrEP in Primary Care" brings the faculty to a practical question: what would help more primary care clinicians feel ready to offer PrEP?

Drawing on her own work in a primary care practice, Dr. Cocohoba asks what would help more colleagues feel comfortable prescribing PrEP. Dr. Urbina says it starts with education on taking a good sexual history, since clinicians who never discuss sexual health will never reach PrEP. Next comes education on the medications themselves. These include two daily oral regimens, event-driven dosing, long-acting cabotegravir every 2 months, and subcutaneous lenacapavir every 6 months. He emphasizes that no single site must do everything. Clinicians can start the conversation, secure buy-in, begin HIV and STI testing, and refer to centers with long-acting injectable infrastructure.

Dr. Cocohoba adds the idea of decentralizing responsibility. Primary care clinicians juggle A1C levels, blood pressure, substance use, and mental health, so PrEP navigators and shared team workflows can ease the reminder burden. She voices mixed feelings about electronic health record prompts but supports making PrEP a team effort. Dr. Urbina agrees and stresses reaching people outside the clinic. He only sees patients who make appointments, missing those who fear stigma, feel embarrassed, or have had poor experiences with health care. Dr. Cocohoba observes that more patients asking for PrEP builds clinician practice and confidence in a reinforcing cycle.

Dr. Urbina would like to see more obstetrician-gynecologists and settings such as Planned Parenthood prescribing PrEP, given their focus on contraception and reproduction. Dr. Cocohoba notes these settings reach young women who are rarely offered PrEP. Dr. Urbina closes by explaining why prevention still matters, even though HIV is now a manageable chronic condition. The viral reservoir drives inflammation, accelerated aging, and end-organ damage. Disclosure and lingering stigma also complicate young people's lives. He calls for renewed urgency, with PrEP as the central tool.

The next episode, "The HIV PrEP Toolbox: Oral Options, Strengths, and Limitations," features Dr. Urbina reviewing the four approved PrEP options and weighing what daily oral regimens do well and where they fall short.