Title : Designing a pre-exposure prophylaxis (PrEP) training for providers to increase PrEP awareness and prescription for black cisgender women
Abstract:
Background: Awareness and uptake of HIV pre-exposure prophylaxis (PrEP) remains low among Black/African American cisgender women at risk for HIV acquisition. Primary care appointments present a valuable opportunity for introducing PrEP to clients; however, primary care providers (PCPs) report minimal comfort level and low familiarity with PrEP. Ensuring PCPs are properly trained on PrEP is crucial as increased PrEP knowledge is associated with higher rates of PrEP prescription and future intent to prescribe. We conducted focus groups with medical providers at community health centers (CHCs) across the Southern and Midwestern United States to identify themes informing the content, design, and delivery of a PrEP provider education aiming to increase PrEP utilization among Black women.
Methods: Focus group discussions occurred with providers at three healthcare organizations in the Midwest and South from August 2022 to February 2023. Providers were asked for input on content and design of provider education regarding PrEP and feedback on preliminary visuals and case scenarios. Transcripts underwent rapid qualitative content analysis using the Stanford Lightning Report Method via Dedoose software. Emergent themes were identified and presented under the domains of the Consolidated Framework for Implementation Research (CFIR).
Results: 10 providers (n=10) completed four focus groups. Themes emerged related to the individual characteristics of providers (limited PrEP knowledge, low comfort initiating PrEP discussions), the outer setting of client needs (perceptions of provider bias in identifying women who are at risk for HIV, varying levels of HIV risk self-perception), and attributes of the inner setting (need for support from the implementing center). Key opportunities were identified to maximize the benefit of training material, design, and delivery (i.e., developing specific case scenarios to enhance providers’ cultural competency with Black women and their overall knowledge regarding PrEP).
Conclusion: A comprehensive PrEP training for providers should feature a combination of didactic material and interactive role-plays to equip providers with knowledge relevant to PrEP prescription for women while building their comfort initiating PrEP discussions with clients. Centers should implement effective and sustainable initiatives to support providers in prescribing PrEP following training completion, such as sharing updated PrEP guidelines and creating quick reference guides.
