Background Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention intervention and a major strategy for reducing the HIV burden in the United States. However, PrEP provision and uptake remain lower than estimated needs, and in ways that may exacerbate HIV disparities among Black adolescent girls and young women in the southern United States. Data suggest that gaps in provider knowledge of HIV epidemiology and PrEP and skills assessing sexual health practices are important barriers to provision and uptake, with limited evidence-based interventions to address these gaps. Objective This paper describes the “PrEP-Pro” intervention, a multicomponent intervention to train and support family medicine (FM) trainees to promote PrEP for adolescent girls and young women in Alabama. Methods The PrEP-Pro intervention comprises 3 main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): (1) provider HIV epidemiology and PrEP education, (2) sexual history taking, and (3) PrEP Champions. In phase 1, we will work with community advisory boards (providers and clients) and then conduct focus groups with FM trainees to adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies, including provider-facing tools and client-facing educational materials. In phase 2, we will pretest and then pilot-test the initially adapted PrEP-Pro intervention with FM trainees. FM trainees will complete baseline, 3-, and 6-month questionnaires post PrEP-Pro intervention. We will also conduct in-depth interviews (IDIs) with FM pilot participants, adolescent girls and young women who accessed care after the PrEP-Pro pilot, and key stakeholders. The primary outcomes are PrEP-Pro acceptability and feasibility, which would be assessed using validated instruments at months 3 (among pretest participants) and 6 (among pilot participants). Secondary outcomes will also be assessed, including PrEP knowledge, sexual history-taking attitudes and practices, PrEP prescriptions among adolescent girls and young women encounters, and sexually transmitted infections (STIs) and HIV testing among adolescent girls and young women encounters in 6 months. Results Study results will be disseminated to practices, state health officials, and other key stakeholders to solicit feedback on implementation opportunities and challenges to inform a hybrid effectiveness implementation trial. Our results will also be presented at local and national conferences and submitted to peer-reviewed journals. Conclusions As PrEP grows, there is a pressing need to train FM providers and develop appropriate, contextually relevant tools to support PrEP implementation. The PrEP-Pro intervention is a multicomponent intervention to train FM residents across Alabama on sexual history-taking, PrEP provision for adolescent girls and young women, and supporting practice-based PrEP Champions. The PrEP-Pro intervention is anticipated to increase PrEP prescriptions for adolescent girls and young women and expand comprehensive sexual and reproductive health care for adolescent girls and young women in rural and urban Alabama. International Registered Report Identifier (IRRID) PRR1-10.2196/44908

BACKGROUND Pre-exposure prophylaxis (PrEP) is widely recognized as a highly effective biomedical prevention intervention and a major strategy for reducing the burden of HIV in the United States. However, PrEP provision and uptake remain low compared to estimated need and in ways that may exacerbate HIV disparities among Black adolescent girls and young women (AGYW) in the US South. OBJECTIVE This protocol paper describes the “PrEP Pro” intervention, a multi-component intervention to train and support family medicine (FM) trainees to promote PrEP for AGYW in Alabama. METHODS The PrEP Pro intervention consists of three main components guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavioral change and the Consolidated Framework for Implementation Research (CFIR): 1) Provider PrEP education, 2) sexual history taking, and 3) PrEP Champions. In phase 1, we will adapt content to train FM residents on HIV epidemiology and PrEP and develop implementation strategies including provider-facing tools and client-facing educational materials. In phase 2, we will pre-test then pilot-test the initially adapted PrEP-Pro intervention with family medicine trainees. The primary outcomes to be assessed include PrEP-Pro acceptability and feasibility. Secondary outcomes will also be assessed including PrEP knowledge, sexual history taking attitudes and practices, PrEP prescriptions among AGYW encounters, and STI and HIV testing among AGYW encounters. The results of this study will inform a hybrid effectiveness-implementation trial RESULTS This study has been approved by the Institutional Review Board of the University of Alabama at Birmingham. Findings from this study will be presented locally to the community advisory board members and disseminated to practices, state health officials, and other key stakeholders. Also, study findings will be presented at local and national conference meetings and submitted to peer-reviewed journals for publication. CONCLUSIONS The PrEP-Pro intervention is a multi-component intervention to train FM residents across Alabama on sexual history taking, PrEP provision for AGYW, and support practice-based PrEP Champions. It is expected that the PrEP-Pro intervention will lead to an increase in PrEP prescriptions to AGYW and an expansion of comprehensive sexual and reproductive health care for AGYW in rural and urban Alabama.