A Theory Informed Multi-Component Intervention to Promote Family Medicine Provider PrEP Prescription to Adolescent Girls and Young Women in the U.S. Southeast: Pilot Trial Results.

Abstract

Adolescent girls and young women (AGYW) in the U.S. Southeast are disproportionately affected by HIV. We developed and piloted PrEP-Pro, an intervention to support family medicine residents to prescribe HIV pre-exposure prophylaxis (PrEP), with a focus on AGYW. We pilot-tested the intervention, evaluating feasibility, acceptability, and appropriateness. Using intervention mapping, we developed sexual history training, PrEP curricula, and a PrEP champion program. For the 6-month pilot test, we trained PrEP champions who trained and supported residents at their sites. Participating physicians completed enrollment and exit questionnaires capturing PrEP provision experiences, attitudes/skills/barriers to completing a sexual history, and PrEP knowledge/attitudes/beliefs. Exit questionnaires assessed PrEP-Pro acceptability, feasibility, and appropriateness. We compared enrollment and exit scores on sexual history assessment, PrEP knowledge, and provider behaviors. Among 46 participants (median age = 29 years), 57% were men, 59% were White, 15% were Asian, 11% were Latinx, and 7% were Black. Among 32 (70%) participants completing both enrollment and exit questionnaires, we observed significant increases in sexual history skills, PrEP knowledge, and PrEP attitudes, and non-significant increases in the proportion reporting routine sexual history assessment and HIV testing. On a 5-point scale, feasibility (mean 4.28 (SD = 0.42), acceptability (4.31 (0.53)), and appropriateness (4.25 (0.46)) scores were high with respect to the PrEP-Pro intervention. This multi-component intervention was feasible, acceptable, and appropriate for family medicine residents in the pilot. Pre- and post-evaluation suggest participation in the intervention increased PrEP knowledge and improved sexual history-taking. These findings suggest that the intervention could successfully enhance provider self-efficacy in delivering sexual health care.