PrEP Training During Residency Increased Knowledge of HIV

Training for pre-exposure prophylaxis (PrEP) that focused on improving knowledge of the prevention method, led to medical residents becoming more comfortable prescribing and managing the medication in patients with HIV, according to a study published in Journal of Primary Care & Community Health. This could help with delivery and uptake of PrEP in the United States.

PrEP is primarily used to prevent HIV, and can reduce the risk of HIV by 99%. However, there is suboptimal delivery and uptake of PrEP in the United States. Lack of knowledge and of comfort in managing and prescribing PrEP have been cited as barriers for primary care physicians (PCPs) when it comes to uptake of PrEP. This study's investigators hypothesized that if PrEP training was included in medical residency, PCPs would have the knowledge and confidence they need to initiate and manage PrEP.

The researchers developed a 40-minute lecture and a 10-question survey based on HIV-PrEP guidelines from the US Preventive Services Task Force (USPSTF) released in 2021. The lecture included information on screening patients who were at high risk of HIV, initiating tenofovir disoproxil fumarate/emtricitabine (FTC) or tenofovir alafenamide/FTC, and managing PrEP in the long term. The survey asked questions about the USPSTF guidelines for PrEP; 9 questions involved knowledge of PrEP and 1 assessed readiness to prescribe.

Male doctor giving a speech on a podium at a conference | Image credit: Ljupco Smokovski - stock.adobe.com

The lecture and survey were included in the internal medicine and pediatric residency curriculum (Meds-Peds) at Rainbow Babies and Children’s Hospital in Clevelad, with attendance made mandatory. The lecture was held remotely 8 times between March and May of 2022. Residents were eligible if they were actively enrolled in the pediatric, internal medicine, or Med-Peds residency program from March to May 2022. Nonresidents, residents with other specialties, and residents who opted out of the survey were excluded. Surveys were given to residents before and after the training to compare their knowledge.

There were 130 residents who completed the presurvey and 107 who completed the post survey. Fifty-six residents in the Pediatric and Med-Peds departments completed the prelecture survey and 45 completed the post lecture compared with 74 and 62 residents from the Internal Medicine Department, respectively.

The median number of correct answers in the section regarding HIV-PrEP knowledge increased from 44% before the lecture to 89% after, same as the Internal Medicine subgroup. whereas the Pediatric and Med-Peds subgroup saw an increase from 33% to 89%.

Only 5.4% of residents responded in the affirmative when asked if they were comfortable initiating and managing HIV-PrEP on their own before the lecture. After the lecture, this jumped to 51.4% overall. The subgroup consisting of residents in the Pediatric and Med-Peds departments reported lower self-efficacy in the use of PrEP compared with the residents from the internal medicine department (OR, 0.383; 95% CI, 0.174-0.845).

There were some limitations to the study. The residents were unpaired for this analysis, and the results relied on a self-assessed survey, which could bias the results. In addition, the generalizability could be limited due to the study taking place in a single institution. Other barriers to PrEP uptake also exist beyond the ones that were covered in the present survey.

The researchers concluded that PCPs can improve their comfort in prescribing and maintaining patients using PrEP if academic programs include the topic in residency programs. The uptake of PrEP could positively benefit from having physicians who are more willing to prescribe PrEP for the prevention of HIV.

Reference

Ogundare MO, Allan F, Desai AP, Dirajlal-Fargo S, Minich NM, Gripshover BM. Integrating HIV pre-exposure prophylaxis (PrEP) education during medical residency: training outcomes and suggestions for learning effectiveness. J Prim Care Community Health. Published online November 7, 2023. doi:10.1177/21501319231207313