Advance-CTR

Advance RI-CTR Pilot Projects Program (Cycle 8)

"DEVELOPMENT AND IMPLEMENTATION OF AN HIV PRE-EXPOSURE PROPHYLAXIS (PREP) TOOLKIT FOR USE WITH ADOLESCENTS AND YOUNG ADULT PATIENTS"

PrEP has the potential to prevent nearly all new HIV infections if scaled appropriately in an at-risk population, which must include AYAs within the U.S. Lack of training among AYA PCPs to conduct comprehensive sexual health evaluations and to discuss PrEP eligibility remain key barriers to uptake in the AYA population. The “PrEP toolkit” and lessons learned from this implementation science project could be scaled to meet the needs of AYA PCPs throughout the U.S. to improve access to PrEP and reduce incident HIV infections among youth.

HIV pre-exposure prophylaxis (PrEP) is extremely effective at preventing sexual transmission of HIV.

Within the U.S., 70% of all new HIV infections are among gay, bisexual, and other men who have sex with men (MSM), and the majority of PrEP implementation has focused on adult MSM. This narrow focus on MSM may lead to missing adolescents and young adults (AYA; ages 14-26) who are at-risk for HIV. Incidence of HIV is increasing among younger populations in the US, largely due to persistently low rates of HIV testing and PrEP uptake in youth. PrEP uptake requires a medical provider, yet many AYA primary care providers (PCPs) have concerns about assessing sexual behavior and lack the comfort, knowledge, and awareness to prescribe PrEP.1 Prior studies have identified multiple key barriers to providers conducting a sexual health assessment and recommending PrEP when indicated including:

(1) evolving guidelines on prescribing, which make it hard for providers to stay current and feeling it is outside of primary care purview,

2 (2) navigating privacy and confidentiality issues given concerns about parents knowing AYA are having sex, identify as sexual and/or gender minorities (SGM) or both3,4 and, lack of provider training around taking a SGM-inclusive sexual health history which can lead to a heterosexual and/or cisgender bias.

5 Recently, PrEP guidelines have been updated to be inclusive of a wider array of individuals appropriate for PrEP, including SGM AYA, making this an appropriate and timely focus of the current project.

6 While primary care settings are key locations for sexual health care among AYA, many providers may be unprepared and miss opportunities to discuss PrEP during visits related to sexual health (i.e., sexual assault, pregnancy concern, STIrelated symptoms), as well as assessing HIV-risk factors among those who present with non-sexual health related issues but who may be at high risk for HIV (i.e., substance use, housing instability).

7,8 To accurately assess AYA HIV risk and identify candidates for PrEP, it is imperative that providers create an affirming space and conduct a comprehensive sexual health history that is inclusive of a range of genders, sexualities, and behaviors. Providers must feel comfortable and confident taking an inclusive sexual healt history initiating a conversation about PrEP using a patient-focused and non-judgmental approach such as motivational interviewing (MI)9, navigating confidentiality issues, prescribing PrEP, and monitoring care.

MI has been used successfully to improve sexual health among SGM and AYA, and is commonly used in primary care for a variety of health behavior change interventions (i.e., sexual risk reduction, reducing substance use,). They must also have supports in place to help them integrate PrEP care into standard clinical practice. The overarching goal of this program of research is to design and implement an AYA PCP “PrEP toolkit” that can support MI-based conversations about PrEP in health care settings to better address the current gap in PrEP care for this population.

To address this goal, the following specific aims are proposed: Specific Aim 1. Formative work with AYA PCPs (N=12-15) to inform the development of a provider led PrEP intervention (training and toolkit) for AYAs. Individual interviews and/or focus groups will be conducted with AYA PCPs to assess

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