Perspectives on HIV PrEP care in Germany: qualitative insights from primary care physicians and specialists

Recently, research has shifted from investigating the effectiveness of HIV pre-exposure prophylaxis (PrEP) to strategizing its implementation. Several European studies have explored physicians' perspectives on implementing PrEP in diverse settings, yet there are no data on the situation in Germany. The purpose of this study was to explore physicians' perspectives on current PrEP care in Germany. From April to July 2018, we conducted 16 semi-structured interviews with HIV providers (HIVPs) and primary care physicians (PCPs). Transcripts were analyzed using thematic content analysis. Physicians showed varying levels of PrEP expertise. Many PCPs lacked knowledge about PrEP. Some PCPs did not support the idea of PrEP as a prophylactic option. Opinions about PCPs' role in PrEP care were diverging, yet most PCPs favored referring PrEP clients to an HIVP or opted for a shared-care arrangement. Perceived problems included stigma and lack of privacy for PrEP care in rural areas. Our findings highlight the need for tailored physician training, which should be addressed in PrEP implementation in Germany.