PrEP Prescription for Black Adolescent Girls and Young Women in Alabama: Findings from a Survey of Healthcare Providers

Abstract

Black adolescent girls and young women (AGYW) are disproportionately affected by HIV in the United States. HIV pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescription rates remain low. We conducted a survey of medical providers caring for Black AGYW in Alabama to explore PrEP prescription practices. While over half of the N = 36 providers reported minimal HIV testing of AGYW in clinic, most (N = 29, 81%) reported feeling confident discussing HIV prevention. Most reported willingness to prescribe PrEP to Black AGYW (58%-72%), but only 11 (31%) had prescribed PrEP to any female client. Low familiarity with CDC guidelines (N = 20, 56%) and PrEP options (N = 19, 53%) were barriers to prescription. Prescribing PrEP to AGYW was associated with provider training, with internal medicine providers being least likely to prescribe. These findings support the need to develop training tools to directly address unique training needs of providers who care for this population.

A Multicomponent Intervention to Train and Support Family Medicine Providers to Promote Pre-exposure Prophylaxis (PrEP) for Adolescent Girls and Young Women in the Deep South: Protocol for the PrEP-Pro Study

“…The 5 domains are (1) intervention characteristics or innovation (ie, the product or the “thing” being implemented), (2) inner setting (ie, setting where the innovation is being carried out), (3) outer setting (ie, setting where the inner setting exists), (4) individuals (ie, roles and responsibilities of individuals), and (5) implementation process (ie, various activities carried out to implement the innovation) [ 44 ]. For example, the individual-level determinants at the provider level that may influence PrEP prescription include knowledge and beliefs around PrEP and conducting a sexual history or risk assessment, and self-efficacy as identified in our studies and also supported by prior literature [ 21 , 22 , 24 , 31 , 45 ]. The inner setting determinants include readiness for change, ease of access to knowledge and information about sexual history taking and PrEP, and leadership engagement within FM training programs to innovate and provide research opportunities for residents.…”

“…Multilevel barriers to PrEP provision and uptake include client-level barriers (such as low PrEP awareness, mistrust of the health care system, and PrEP-associated stigma) [18][19][20][21], health care system-level barriers (such as knowledge gaps and comfort among providers, unconscious bias, and racism) [22][23][24], and structural-level barriers (such as costs, reimbursement, and lack of health insurance) [24][25][26]. More specifically, in the South, PrEP provision and uptake have been limited by geographical factors-living in rural areas with limited access to PrEP providers [7], provider and health care system factors, including PrEP knowledge [27], provider sexual assessment skills [27], perceived provider racism [28], PrEP stigma [28,29], and health care capacity, among many other factors [7,30,31]. Thus, training providers in taking a sexual history and PrEP clinical care may be a successful strategy to increase PrEP use among Black adolescent girls and young women in the South [31][32][33][34].…”

“…More specifically, in the South, PrEP provision and uptake have been limited by geographical factors-living in rural areas with limited access to PrEP providers [7], provider and health care system factors, including PrEP knowledge [27], provider sexual assessment skills [27], perceived provider racism [28], PrEP stigma [28,29], and health care capacity, among many other factors [7,30,31]. Thus, training providers in taking a sexual history and PrEP clinical care may be a successful strategy to increase PrEP use among Black adolescent girls and young women in the South [31][32][33][34].…”

Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training

“…Customized provider training has been associated with effective implementation of other healthcare interventions, such as improving negative attitudes towards buprenorphine prescription for opioid use disorder [ 32 ] and facilitating effective implementation of evidence-based tobacco use treatment in health centers [ 37 ]. Emerging PrEP literature also supports customized training; recent studies indicated the need for (1) tailoring training to provider needs [ 38 ] and (2) provider preferences regarding PrEP training content and format depending on clinical experience [ 8 , 33 ]. Other studies have shown clinician mentoring programs to be successful training models to bolster the HIV workforce [ 39 , 40 ].…”

“Nobody Wants to Have Conversation About HIV.” A Thematic Analysis of in-Depth Interviews With Black Adolescent Women and Providers About Strategies for Discussing Sexual Health and HIV Prevention

“…[7][8][9][10][11][12][13] Provider challenges include familiarity with PrEP guidelines, competing demands, discomfort assessing sexual health, low provider-perceived client risk, maintaining AGYW confidentiality, and adherence concerns. 8,14,15 Our previous work among Black AGYWand providers illustrates that these barriers are amplified in the Deep South, and sexual health conversations are not routine. 8,14,16 Preexposure prophylaxis disparities between the Deep South and the remainder of the country will persist without implementation of innovative interventions.…”