Knowledge gaps and structural barriers to prescribing pre-exposure prophylaxis among healthcare providers in North Louisiana: A cross-sectional study.

Abstract

Pre-exposure prophylaxis (PrEP) uptake remains low in the Southern United States, despite disproportionate HIV burden. This study aimed to assess knowledge, attitudes, and structural barriers influencing PrEP prescribing among healthcare providers in North Louisiana. We conducted a cross-sectional survey from January 2024 to April 2025 among 102 healthcare providers at a medical school and an affiliated hospital in North Louisiana. The survey assessed knowledge of PrEP, prescribing practices, and the perceived barriers. Descriptive statistics and multivariable logistic regression analysis were performed. Among 102 healthcare providers, only 27.5% had ever prescribed PrEP, and 48% had never discussed it with patients. The most frequently reported barriers to prescribing PrEP were lack of provider training (84.3%) and absence of clinical guidelines (68.6%). Multivariable analyses showed that providers with higher self-rated PrEP knowledge were significantly more likely to discuss PrEP with patients (adjusted odds ratio [aOR]: 5.10; 95% confidence interval [CI]: 2.31-11.27) and to prescribe PrEP (aOR: 3.29; 95% CI: 1.72-6.30). Significant gaps in provider knowledge and institutional readiness persist in high-burden Southern settings. Targeted provider training and supportive institutional policies are essential to improving PrEP implementation.