507 - Trainees' Confidence in Prescribing Pre-Exposure Prophylaxis (PrEP)

Poster Number: 507
Publication Number: 507.100

Anjali S. Vora, University of Texas Southwestern Medical Center, Dallas, TX, United States; Carmen Johnson, University of Texas Southwestern Medical School, Carrollton, TX, United States; Jackson M. Francis, The University of Texas Health Science Center School of Public Health, Grand Prairie, TX, United States; Jasmin A. Tiro, UT Southwestern Medical Center, Dallas, TX, United States; Katelyn K. Jetelina, UTHealth, Dallas, TX, United States; Jenny Francis, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: The southern region has the highest rate of newly diagnosed HIV in the US. Physicians in training are often the first providers to discuss sexual health and prevention with adolescents/young adults seen at academic medical centers.

Objective: Evaluate trainees’ confidence in prescribing Pre-Exposure Prophylaxis (PrEP) for HIV prevention.

Design/Methods: Residents/fellows in Pediatrics, Obstetrics-Gynecology, and Family Medicine training programs at a large Southern medical center were invited to complete a survey collecting demographics (gender, ethnicity, race), training experiences (state of medical school, residency program), and personal characteristics (sexual orientation, political affiliation, religion). Two items asked if participants were taught how to prescribe PrEP (yes/no) and how to do it in a confidential manner (yes/no). The main outcome was confidence in those two communication behaviors, measured on a 4-point Likert scale and dichotomized into not confident vs. slightly/moderately/very confident for bivariate analysis.

Results: Of the 228 respondents (63% of invitees), most were female (76%), non-Hispanic (89%), white (56%) and completed medical school in the South (60%). Most were pediatrics trainees (61%); identified as heterosexual (92%) or other (6%); identified as liberal (51%) and the most common religious affiliation was Christianity (45%). Most (57%) reported that they were not taught how to prescribe PrEP and 44% were not taught how to prescribe in a confidential manner. In terms of confidence, 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 were taught how to prescribe were more confident in prescribing PrEP (OR 10.33, 95%CI 5.35 - 19.95) and prescribing in a confidential manner (OR 3.43, 95%CI 1.65 - 7.12). Non-Hispanic trainees (OR 3.12, 95%CI 1.22 - 7.99) and those identifying as other sexual orientation (OR 4.90, 95%CI 1.07 - 22.49) were more likely to report higher confidence in prescribing PrEP. There were no significant characteristics associated with prescribing in a confidential manner.Conclusion(s): In this sample of Southern trainees, a substantial number reported not being trained in how to communicate about and prescribe PrEP. Lack of training was associated with low confidence. Given the continued high rates in Southern cities, it is critical to identify patients eligible for this HIV prevention tool. Future studies should evaluate tailored curricula for trainees that highlight the importance of PrEP and build communication skills around confidential prescribing.
Vora_CV.pdf