PrEP Pro: Adapting a multi-component intervention to train and support providers to promote PrEP for adolescent girls and young women in the Deep South

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Narrative/Abstract Black adolescent girls and young women (AGYW) are at high-risk for HIV acquisition. Antiretroviral medication for pre-exposure prophylaxis (PrEP) is an effective, female-controlled strategy to dramatically reduce HIV-acquisition risk, but uptake is low. With funding from an Ending the HIV Epidemic (EtHE) supplement to the UAB Center for AIDS Research, we surveyed and interviewed health care providers working in Alabama. Our data suggest that providers do not consider prescribing PrEP to Black AGYW. Important barriers include client, provider, and community stigma around sexuality, challenges of obtaining a sexual history, limited training on PrEP indications and management, and structural limitations related to insurance. Using the Intervention Mapping, and the Capability-Opportunity-Motivation-Behavior model for behavioral change, we propose to adapt evidence-based curriculum on HIV epidemiology, PrEP indications and efficacy; skills building and client-facing tools for obtaining sexual histories; and provider PrEP Champions to create a multi-component context-specific provider intervention, PrEP-Pro. In Aim 1, we will adapt PrEP-Pro to Family Medicine trainees due to their role in caring for adolescents at stages of transition and substantial contributions to rural healthcare. We focus on residents in training to leverage trainee mindset and energy while seeding the Family Medicine workforce with PrEP informed providers. We will convene an advisory board of providers, PrEP Champions, AGYW, and clinic administrators to adapt existing content to the local context. We will solicit feedback on PrEP-Pro content from providers and AGYW through focus group discussions. In Aim 2, we will pre-test the adapted PrEP-Pro content with up to 12 Family Medicine residents and 2 PrEP Champions in rural and urban AL and further hone PrEP-Pro based on their feedback via surveys and in-depth interviews. We will then conduct an open pilot with 60 Family Medicine residents. Primary pilot outcomes are acceptability and feasibility. We will also measure PrEP knowledge and attitudes as well as PrEP prescribing patterns and HIV/STI testing in the 6-month periods pre- and post-intervention. In Aim 3 we will elucidate determinants to PrEP-Pro implementation by conducting in-depth interviews with providers, AGYW, and other key stakeholders, reviewing findings with our CAB, and seeking additional input through dissemination events to inform a future hybrid effectiveness/implementation trial. With expertise in adolescent health, sexual health, adult medical education, PrEP, qualitative methods, community-engaged research, and intervention development and a team led by women and African-American clinician-scientists who work, live, teach, and provide care in the Deep South, we are well-positioned to complete the proposed science, disseminate information to key stakeholders and policy makers, and apply these data to inform interventions to mitigate HIV for AGYW in the Deep South.