Barriers, Facilitators, and Training Preferences for HIV PrEP Among Physicians in the State of Louisiana, USA

HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection, yet its implementation remains suboptimal in the Southern United States. This study examined barriers, facilitators, and training preferences related to PrEP implementation among physicians at an academic medical center in North Louisiana. A cross-sectional electronic survey was conducted between January 2024 and April 2025 among physician faculty, residents, and fellows. Participants reported perceived barriers and facilitators to PrEP implementation, preferred training topics and modalities, and demographic characteristics. Descriptive statistics summarized responses, and linear regression identified factors associated with physicians' PrEP implementation training scores. The most commonly reported barriers were lack of provider training, insurance and cost-related concerns, lack of clinical protocols, staffing and time constraints, and limited knowledge of laboratory monitoring. Frequently identified facilitators included access to clinical protocols, peer support, pharmacist support, and electronic medical record (EMR) order sets. Physicians most frequently requested training on PrEP eligibility, side effects and toxicity, and contraindications, with in-person training as the preferred format. Physicians identified substantial educational and structural barriers to PrEP implementation despite strong support for institutional strategies that facilitate prescribing. Expanding physician education while integrating standardized protocols, pharmacist support, and EMR-based decision tools may strengthen PrEP implementation in high HIV-burden regions of the Southern United States.