(P155) EVALUATING THE IMPACT OF PROVIDER-DIRECTED QUALITY IMPROVEMENT INTERVENTIONS ON HIV PRE-EXPOSURE PROPHYLAXIS PRESCRIBING PATTERNS BY PRIMARY CARE PROVIDERS IN A LARGE SAFETY-NET AMBULATORY CARE NETWORK.

Background:
Despite overall increased use of oral HIV Pre-Exposure Prophylaxis (PrEP) medications since tenofovir/emtricitabine was approved for this indication in 2012, it remains an underutilized tool for HIV prevention. Previous studies demonstrated that clinician-directed educational interventions increase providers’ confidence prescribing PrEP. However, there is limited research evaluating the impact of these interventions on rates of PrEP prescribing.

Methods:
We implemented a set of interventions for primary care providers in the Los Angeles County Department of Health Services Ambulatory Care Network (ACN) during 2021-2022 that included educational sessions, an Expected Practices guide, and an electronic medical record order set for PrEP prescribing. Oral PrEP prescriptions were pulled for the years 2019 and 2022 and the rates per 100,000 empaneled patients were tested for differences using Fisher’s exact test. Patient characteristics were compared with 2-tailed Fisher’s exact test.

Results:
Oral PrEP use increased from 84 to 144 unique patient prescriptions (27.7 to 32.7 per 100,000; p=0.25). Patients who received PrEP did not differ by age (p= 0.88), race (p= 0.85) or ethnicity (p= 0.88) between 2019 and 2022. The largest represented groups in 2022 were aged 25-34 (42.4%), Hispanic ethnicity (43.1%), and cisgender males (88.2%).  The proportion of Black PrEP patients increased from 5.9% in 2019 to 11.1% in 2022. Patient-driven prescriptions decreased from 56.0% to 47.2% , and provider-driven prescriptions decreased from 39.3% to 8.3% (p < 0.001), a difference likely driven by poor documentation in 2022 (44.4% unknown).

Conclusion:
Provider-directed interventions did not lead to a significant increase in the rate of PrEP prescribing in the ACN, despite absolute numbers increasing. This population warrants particular focus due to the high proportion of patients who are Hispanic and/or Black, as these groups experience disparities in PrEP access. More research is needed to determine optimal strategies for increasing PrEP utilization in primary care settings serving safety-net populations.