Residents and Fellows’ Confidence in Prescribing Pre-exposure Prophylaxis (PrEP)

• Published in: Academic pediatrics Vol. 23; no. 6; pp. 1282 - 1287
• Main Authors: Vora, Anjali S., Marroquin, Monica, Rosenthal, Susan L., Broker, Paul, Jetelina, Katelyn, Tiro, Jasmin A., Francis, Jenny KR
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2023
• Subjects: adolescent; HIV; medical education; pre-exposure prophylaxis; sexual reproductive health; adolescent; pre-exposure prophylaxis; HIV; medical education; sexual reproductive health
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2023.02.017

Residents and fellows are often the first health care providers to discuss sexual health and prevention with adolescents and young adults at academic institutions. This study characterized when learners in Pediatrics, Obstetrics and Gynecology, and Family Medicine believed that one should receive training in pre-exposure prophylaxis (PrEP) and it described confidence in prescribing PrEP.
Learners at a large, urban, southern academic center completed an online survey about adolescent sexual health services. Measures included whether participants were taught how to prescribe PrEP and how to do so in a confidential manner. Confidence in these two behaviors was measured with a Likert scale and dichotomized for bivariate analysis.
Among the 228 respondents (63% response rate), most learners preferred sexual health communication to be emphasized early in medical school and throughout training. Overall, 44% reported being “not confident at all” in prescribing PrEP, and 22% were “not confident at all” in prescribing in a confidential manner. Those who reported “not confident at all" in prescribing PrEP were more likely in pediatrics (51%) than family medicine (23%) or obstetrics-gynecology (35%) (P < .01). Those who had been taught how to prescribe were more confident in prescribing PrEP (P ≤ .01) and prescribing in a confidential manner (P < .01).
Given the continued high rates of new human immunodeficiency virus infections among adolescents, effective communication with patients eligible for PrEP is critical. Future studies should evaluate and inform tailored curricula about the importance of PrEP and build communication skills around confidential prescribing.