Adapting an Intervention to Improve Adolescent Sexual Health Assessment and Pre-Exposure Prophylaxis Prescription by Family Medicine Physicians in Alabama.

Abstract

High HIV incidence in the US South disproportionately affects adolescents, young adults, and Black women. Using a community-engaged approach and intervention mapping, we developed PrEP-Pro, an intervention to support family medicine physician-trainees to elicit a sexual history from and provide pre-exposure prophylaxis (PrEP) to adolescents, with special emphasis on engaging with Black adolescent girls and young women (AGYW). Intervention content includes PrEP curricula, adaptations to the Centers for Disease Control and Prevention (CDC)'s sexual history tool, and a PrEP Champion training program. Two community advisory boards (CABs)-one consisting of PrEP Champions and physicians, the other of AGYW-and two focus group discussions with physicians (N = 7) informed intervention content. We pretested PrEP-Pro at two sites over 3 months and assessed acceptability, appropriateness, feasibility. The provider CAB advised multiple training strategies: (1) locally informed sexual history videos; (2) HIV epidemiology review; (3) quick-reference badge and pocket cards on PrEP and eliciting sexual histories; (4) didactic, case-based content; (5) web-based content. The AGYW CAB informed development of (6) a sexual history screener and (7) clinic posters emphasizing confidentiality for adolescent clients. Across two family medicine residency programs, eight physicians participated in the 3-month pretest of the intervention. Acceptability (mean = 4.16/5 [standard deviation (SD) = 1.36]), appropriateness (4.16/5 [1.36]), and feasibility (4.19/5 [1.37]) were high. Six physician interviews informed adaptations including fostering a community of practice, increased case-based learning, and quick-reference card content modifications. We combined theory-driven and evidence-informed components to adapt and pilot PrEP-Pro to support physicians in discussing PrEP with adolescents. The adapted intervention was piloted across clinics to inform a future trial.