by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

March 14, 2023

Featured Literature:

Vora AS, Marroquin M, Rosenthal SL, et al.  Residents and fellows’ confidence in prescribing pre-exposure prophylaxis (PrEP).  Acad Pediatr.  2023 Mar 7;S1876-2859(23)00060-8.  PMID: 36893907.    

This study evaluated PrEP training and confidence among 228 learners at a large, urban southern academic medical center.  Learners, which included residents and fellows in Categorical Pediatrics, Combined Internal Medicine-Pediatrics, Pediatric Neurology, OBGYN, and Family Medicine, completed a 30-item online survey about adolescent sexual health services (the survey was administered September to November 2020), of which 4 items focused on PrEP.  35% of respondents indicated they thought sexual and reproductive health communication training should occur throughout training (i.e., emphasized early in medical school and continue throughout training), and 14% thought it should wait until residency or fellowship.  44% reported being “not confident at all” in prescribing PrEP – this was associated with not identifying as a sexual minority, not having been taught how to prescribe PrEP, and being a pediatric learner.  22% were also “not confident at all” in prescribing PrEP in a confidential manner.  Since there was a greater percentage of fellows among pediatric learners, investigators also assessed data after removing fellows’ responses: sub-analysis findings were consistent with the overall analysis that more pediatric learners (66%) indicated they were “not confident at all’ in prescribing PrEP compared with family medicine (24%) or OBGYN (10%) learners.

Author’s Commentary:

A small number of studies have sought to describe experiences and preferences of health professions learners with regard to PrEP training and skills building, with many focusing on medical students (and fewer looking at nursing and pharmacy students, or residents/fellows).  This study builds upon prior efforts which focused on learners who work directly with adolescents and young adults, and indicates that many pediatric and other primary care residents/fellows believe sexual and reproductive health communication training should begin early in order to build confidence.  A substantial portion of learners were not at all confident with regard to prescribing PrEP in general, and also not confident in prescribing PrEP confidentially.  This has notable implications for the future of PrEP access, and potentially also the quality of PrEP services.  Given ongoing interest in a National PrEP Program, juxtaposed against efforts to limit PrEP access in some states/jurisdictions, studies such as this can help identify ‘high yield’ opportunities to increase the capacity, confidence, and motivation of the future HIV workforce.

The author has no conflicts of interest to disclose.

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