Developing an HIV Pre-Exposure Prophylaxis Toolkit for Adolescent and Young Adults: Serving Primary Care Providers to Support Future Implementation Using the Consolidated Framework for Implementation Research.

Abstract

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy for adolescents and young adults (AYAs, ages 14-26). PrEP uptake among AYAs remains low. Barriers to uptake include provider discomfort discussing sexuality, challenges engaging parents in sexual health conversations, and low perceived HIV risk. To address these gaps, we aimed to develop a toolkit to enhance AYA-serving primary care providers' (PCPs) comfort and confidence in discussing and prescribing PrEP. The Consolidated Framework for Implementation Research informed our approach. Four focus groups with youth-serving PCPs across three clinics in a Northeastern US city were held in April and May 2024. PCPs included residents (n = 10), attending physicians (n = 11), nurse practitioners (n = 2), and a physician assistant (n = 1). Debrief summaries were created following each focus group and analyzed. We used a rapid qualitative process, guided by an a priori codebook and reflexive thematic analysis. PCPs emphasized that the toolkit should be easy to access, interactive, and provide practical, age-appropriate prescribing information. They identified outer-setting factors such as the role of parents in AYAs' health care, sexual health education in schools, and uncertainty around laws that impact PrEP provision to minors. Within the clinical setting, providers noted that limited time often hindered sexual health discussions. Individually, PCPs reported moderate comfort with PrEP and were motivated to prescribe PrEP when AYAs expressed interest. Findings informed the development of a PrEP toolkit tailored for AYA-serving PCPs and future implementation tailored for AYA-serving PCPs. This approach may help expand access and address persistent barriers to PrEP uptake among AYAs.