Rural providers’ attitudes toward integrating harm reduction strategies and PrEP prescribing into rural primary care settings in the US, Southeast and Midwest
An article in Addiction Science & Clinical Practice, published September 12, 2025.
Authors: Phillip L. Marotta, Miryam Biaid, Robert Heimer, Debbie Humphries, Katie Wang, Nithya Narayanan, Zach Lynch, Virginia McKay, Hilary Reno, Rachel Winograd, Dawn Goddard-Eckrich, Lindsey Filiatreau, Kristi Stringer, Kaileigh Backes, Patricia Cavazos-Rehg
This study looks at the attitudes of healthcare providers in rural areas of the Southeast and Midwest United States towards harm reduction strategies and prescribing PrEP. The aim was to understand how these attitudes might affect whether providers prescribe PrEP to patients, especially those with opioid use disorders (OUD).
Key Findings:
PrEP Prescribing Rates: About 62.1% of rural health care providers in the study prescribed PrEP to their patients in the past year.
Positive Attitudes Influence Prescribing: Providers who believe that making it easier to prescribe buprenorphine (a medication for OUD) helps their work were more likely to prescribe PrEP. Those open to including naloxone distribution (a drug that reverses opioid overdoses) and syringe exchange programs (which provide clean needles to prevent infection) in their clinics also tended to prescribe PrEP more often.
Facility Size and Training Matter: Providers from larger health facilities were more likely to prescribe PrEP. Those with specialized training in infectious diseases were also more likely to write PrEP prescriptions.
Integration in Care: Promoting positive attitudes towards integrating harm reduction strategies (like syringe exchanges and naloxone distribution) in primary care could increase the prescribing of PrEP.
Provider Education and Support: Encouraging educational efforts and supportive policies that make it easier for providers to prescribe medications like buprenorphine and integrate comprehensive harm reduction strategies may improve health outcomes.
This study suggests that combining harm reduction services with PrEP prescribing might reduce the negative impacts of drug use, including overdose and HIV infection, especially in rural areas where these services are less common.