021 - From Knowledge to Practice: Empowering Outpatient Pediatricians to Manage HIV PrEP Among Adolescents Through a Quality Improvement Pilot

Publication Number: 21.5017

Lorato Anderson, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; David P.. Anderson, Quant & Qual Evaluation Services, Hamilton, NJ, United States; Abigail C. Winkelmann, Children's Hospital of Richmond at VCU, Richmond, VA, United States

Background: In 2022, an estimated 20% of all new HIV infections in the US occurred among individuals aged 13–24 years old. Pediatricians are vital to adolescent PrEP access. However, lack of pediatrician knowledge about PrEP options and discomfort with PrEP management are barriers to youth access. This pilot integrates a Key Driver Diagram, PrEP comfort and knowledge assessments, training intervention, and clinical support tools.

Objective: To collect information about baseline knowledge and comfort of outpatient pediatricians with PrEP management among adolescents followed by a training intervention and support tools.

Design/Methods: Ten pediatricians at an outpatient primary care clinic completed a baseline PrEP knowledge and comfort assessment followed by a 60-minute PrEP training. Providers received clinical support tools during the training including a reference sheet on PrEP management and access to an EMR shared folder to quickly order PrEP labs and medications. Knowledge and comfort assessments were repeated immediately after and two months after the training. EMR PrEP prescription data was collected.

Results: At baseline, providers had low comfort levels regarding knowledge of required labs for PrEP initiation and management, PrEP specific patient counseling, determining if PrEP is indicated, and prescribing PrEP (Fig. 1). Only 50% of pediatricians could name one PrEP medication. Immediately after training, all but one pediatrician named all three PrEP medications. Pediatricians showed good retention of this knowledge as over half remembered the names of at least two PrEP medications two months after the training. There was an increase in self-reported oral PrEP prescriptions 2 months following the training (Fig. 2), which was substantiated by EMR data (Fig. 3).

Conclusion(s): Data from this pilot revealed gaps in pediatrician comfort and knowledge of PrEP specific counseling and management. An educational intervention improved providers’ PrEP comfort (Fig. 1) and led to a significant increase in self-reported PrEP discussions with patients (Fig. 2). Self-reported PrEP prescriptions increased 2 months after training, but not significantly. EMR data shows that pediatricians have continued to prescribe PrEP in succeeding months (Fig. 3). As expected, PrEP discussions increased at a higher rate than prescriptions as not every adolescent patient is eligible for PrEP. Provider feedback indicated the need for PrEP educational handouts with youth-friendly language in multiple languages. Training feedback was used to improve the training and resources prior to further rollout.

Figure 1. Pediatrician Self-Assessed Comfort
Items in red indicate statistically significant increases. The item in blue indicates an increase that was not significant. Items in black show no meaningful changes.

Figure 2. Pediatrician Self-Reported Practices
Items in red indicate statistically significant increases. The item in blue indicates an increase that was not significant. Items in black show no meaningful changes.

Figure 3. EMR Data of oral PrEP Prescriptions
EMR data showing increased and continued PrEP prescriptions following PrEP training.