{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T18:04:10Z","timestamp":1779818650534,"version":"3.53.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201311.27) and to prescribe PrEP (aOR: 3.29; 95% CI: 1.72\u20136.30).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346890","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T17:26:02Z","timestamp":1779816362000},"page":"e0346890","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge gaps and structural barriers to prescribing pre-exposure prophylaxis among healthcare providers in North Louisiana: A cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7880-9614","authenticated-orcid":true,"given":"Deborah G.","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Pichilingue-Reto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine G.","family":"Dean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Malek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Enrique","family":"Espinoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"pone.0346890.ref001","author":"CDC","year":"2024"},{"key":"pone.0346890.ref002","unstructured":"KFF analysis of Centers for Disease Control and Prevention. National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) AtlasPlus. 2024. [cited 2025 June 9]. https:\/\/www.kff.org\/state-category\/hivaids\/?state=LA"},{"key":"pone.0346890.ref003","unstructured":"AIDSVu. AIDSVu Releases New PrEP Data and Launches PrEPVu.org, A New PrEP Equity Platform. 2024. [cited 2025 June 9]. https:\/\/aidsvu.org\/news-updates\/aidsvu-releases-new-prep-data-and-launches-prepvu-org-a-new-prep-equity-platform\/"},{"issue":"5","key":"pone.0346890.ref004","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1007\/s10900-017-0325-8","article-title":"State of HIV in the US Deep South","volume":"42","author":"S Reif","year":"2017","journal-title":"J Community Health"},{"issue":"4","key":"pone.0346890.ref005","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s11904-019-00447-4","article-title":"Implementation strategies to increase PrEP uptake in the South","volume":"16","author":"PS Sullivan","year":"2019","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"pone.0346890.ref006","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/COH.0000000000000206","article-title":"The role of healthcare providers in the roll out of preexposure prophylaxis","volume":"11","author":"DS Krakower","year":"2016","journal-title":"Curr Opin HIV AIDS"},{"key":"pone.0346890.ref007","volume-title":"Sample size determination in health studies: a practical manual","author":"SK Lwanga","year":"1991"},{"issue":"9","key":"pone.0346890.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0238375","article-title":"Healthcare practitioner experiences and willingness to prescribe pre-exposure prophylaxis in the US","volume":"15","author":"AA Leech","year":"2020","journal-title":"PLoS One"},{"key":"pone.0346890.ref009","doi-asserted-by":"crossref","first-page":"105875","DOI":"10.1016\/j.ypmed.2019.105875","article-title":"HIV prescriptions on the frontlines: primary care providers\u2019 use of antiretrovirals for prevention in the Southeast United States, 2017","volume":"130","author":"KD Henny","year":"2020","journal-title":"Preventive Medicine"},{"issue":"5","key":"pone.0346890.ref010","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1007\/s10461-016-1625-1","article-title":"PrEP awareness, familiarity, comfort, and prescribing experience among US Primary Care providers and HIV specialists","volume":"21","author":"AE Petroll","year":"2017","journal-title":"AIDS Behav"},{"issue":"12","key":"pone.0346890.ref011","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.annepidem.2018.06.005","article-title":"The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States","volume":"28","author":"AJ Siegler","year":"2018","journal-title":"Ann Epidemiol"},{"issue":"8","key":"pone.0346890.ref012","article-title":"Barriers and facilitators that influence HIV Pre-exposure Prophylaxis (PrEP)-prescribing behaviors among primary care providers in the Southern United States","volume":"16","author":"DO Traylor","year":"2024","journal-title":"Cureus"},{"issue":"5","key":"pone.0346890.ref013","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1080\/00224499.2022.2110208","article-title":"Sources of information about pre-exposure prophylaxis (PrEP) and associations with PrEP stigma, intentions, provider discussions, and use in the United States","volume":"60","author":"JL Walsh","year":"2023","journal-title":"The Journal of Sex Research"},{"key":"pone.0346890.ref014","doi-asserted-by":"crossref","first-page":"21501319221147254","DOI":"10.1177\/21501319221147254","article-title":"Primary care provider HIV PrEP knowledge, attitudes, and prescribing habits: a cross-sectional survey of late adopters in rural and suburban practice","volume":"14","author":"J Sell","year":"2023","journal-title":"J Prim Care Community Health"},{"issue":"22","key":"pone.0346890.ref015","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.3390\/healthcare12222315","article-title":"Assessing knowledge, practices, and barriers to PrEP and nPEP prescription among texas healthcare providers","volume":"12","author":"YM Tiruneh","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"pone.0346890.ref016","article-title":"Provider knowledge gaps in HIV PrEP affect practice patterns in the US Navy","volume":"185","author":"K Wilson","year":"2020","journal-title":"Mil Med"},{"issue":"5","key":"pone.0346890.ref017","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1007\/s12325-020-01295-0","article-title":"Barriers to the wider use of pre-exposure prophylaxis in the United States: a narrative review","volume":"37","author":"KH Mayer","year":"2020","journal-title":"Adv Ther"},{"issue":"7","key":"pone.0346890.ref018","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1007\/s10461-024-04332-z","article-title":"Identifying best practices for increasing HIV Pre-exposure Prophylaxis (PrEP) use and persistence in the United States: a systematic review","volume":"28","author":"U.S. Centers for Disease Control and Prevention\u2019s Prevention Research Synthesis Project","year":"2024","journal-title":"AIDS Behav"},{"issue":"12","key":"pone.0346890.ref019","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(23)00256-4","article-title":"HIV pre-exposure prophylaxis and its implementation in the PrEP Impact Trial in England: a pragmatic health technology assessment","volume":"10","author":"AK Sullivan","year":"2023","journal-title":"Lancet HIV"},{"issue":"3","key":"pone.0346890.ref020","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1055\/a-2524-4993","article-title":"Association of an HIV-prediction model with uptake of preexposure prophylaxis","volume":"16","author":"S Romero","year":"2025","journal-title":"Appl Clin Inform"},{"key":"pone.0346890.ref021","first-page":"20499361241303415","article-title":"Pre-exposure prophylaxis access, uptake and usage by young people: a systematic review of barriers and facilitators","volume":"11","author":"S Warzywoda","year":"2024","journal-title":"Ther Adv Infect Dis"},{"key":"pone.0346890.ref022","doi-asserted-by":"crossref","first-page":"2325958220919269","DOI":"10.1177\/2325958220919269","article-title":"\u201cA Good Habit\u201d: Telehealth PrEP users find benefit in quarterly monitoring requirements","volume":"19","author":"KA Koester","year":"2020","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"2","key":"pone.0346890.ref023","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s11904-024-00697-x","article-title":"Leveling Up PrEP: implementation strategies at system and structural levels to expand PrEP use in the United States","volume":"21","author":"SE Rutstein","year":"2024","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"13","key":"pone.0346890.ref024","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1080\/10410236.2020.1787927","article-title":"Provider-patient communication on Pre-Exposure Prophylaxis (Prep) for HIV prevention: an exploration of healthcare provider challenges","volume":"36","author":"K Wilson","year":"2021","journal-title":"Health Commun"},{"issue":"3","key":"pone.0346890.ref025","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1089\/apc.2019.0189","article-title":"Health care provider barriers to HIV pre-exposure prophylaxis in the United States: a systematic review","volume":"34","author":"B Pleuhs","year":"2020","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"pone.0346890.ref026","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1089\/apc.2019.0219","article-title":"Perceptions of patient HIV risk by primary care providers in high-HIV prevalence areas in the Southern United States","volume":"34","author":"K Drumhiller","year":"2020","journal-title":"AIDS Patient Care STDS"},{"key":"pone.0346890.ref027","unstructured":"U.S. Department of Health and Human Services. Ready, Set, PrEP program. 2024. https:\/\/www.getyourprep.com"},{"key":"pone.0346890.ref028","unstructured":"Gilead S. Advancing Access\u00ae program. 2024. https:\/\/www.gileadadvancingaccess.com"},{"key":"pone.0346890.ref029","author":"The White House","year":"2021"},{"issue":"5","key":"pone.0346890.ref030","first-page":"348","article-title":"Training obstetrician gynaecologists in HIV PrEP (pre-exposure prophylaxis): a 2-year experience","volume":"99","author":"F Silvestri","year":"2023","journal-title":"Sex Transm Infect"},{"issue":"2","key":"pone.0346890.ref031","doi-asserted-by":"crossref","DOI":"10.1097\/QAI.0000000000001890","article-title":"Comfort discussing HIV pre-exposure prophylaxis with patients among physicians in an urban emergency department","volume":"80","author":"BA Tortelli","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"12","key":"pone.0346890.ref032","doi-asserted-by":"crossref","first-page":"3456","DOI":"10.1007\/s10461-020-02916-z","article-title":"Medical mistrust and the PrEP cascade among latino sexual minority men","volume":"24","author":"D Kimball","year":"2020","journal-title":"AIDS Behav"},{"key":"pone.0346890.ref033","article-title":"Addressing disparities in Pre-Exposure Prophylaxis (PrEP) access: implementing a community-centered mobile PrEP program in South Florida","author":"S Butts","year":"2023","journal-title":"Res Sq"},{"issue":"9","key":"pone.0346890.ref034","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1001\/jama.2019.1343","article-title":"Ending the HIV epidemic: a plan for the United States","volume":"321","author":"AS Fauci","year":"2019","journal-title":"JAMA"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346890","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T17:26:17Z","timestamp":1779816377000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346890"}},"subtitle":[],"editor":[{"given":"Ayodeji Babatunde","family":"Oginni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0346890","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]}}}