Academic Detailing to Optimize PrEP Implementation in Pediatric Primary Care Settings: ADOPT-PrEP

Boston Children'S Hospital, Boston MA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Adolescents and young adults (AYA) account for nearly 20% of new HIV diagnoses in the United States. However, very few sexually active adolescents have used pre-exposure prophylaxis (PrEP), despite it being safe, highly effective at preventing HIV transmission, and FDA-approved for youth. Pediatric health care providers could have a major impact on PrEP use for youth, as they are trusted sources of health information for AYA, and every individual who uses PrEP must obtain it from a clinician. Although CDC recommends that providers speak with all sexually active youth about PrEP, pediatricians infrequently discuss or prescribe this medication, in large part due to lack of knowledge and training in PrEP. Without strategies to train and engage pediatricians in effective implementation of PrEP, including discussing, prescribing, and supporting persistence, its impact for youth will remain unrealized. Academic detailing, an evidence-based, 1-on-1 educational outreach technique for clinicians, could improve PrEP prescribing and persistence for this population. Academic detailing has been associated with substantial increases in PrEP prescribing by clinicians in adult settings and has the potential to improve pediatric PrEP. Dr. Carly Guss’ long-term goal is to improve PrEP use and impact for youth. The objective of this proposal, the first step towards her goal, is to develop an implementation strategy for PrEP based on academic detailing that can improve prescribing to AYA. The research setting is a large children’s hospital and affiliated community health center in an HIV priority jurisdiction (Boston, MA) with a major unmet need for PrEP. The specific aims are to: 1) Explore barriers and facilitators to PrEP discussions, prescribing, and persistence among AYA and identify educational needs of pediatric health care providers. Using; 2) Develop a novel implementation strategy for PrEP in pediatric settings by locally adapting an existing PrEP academic detailing campaign; and 3) Conduct a pilot study of our PrEP implementation strategy for AYA. This proposal is significant in addressing the National HIV/AIDS Strategy goals to prevent new HIV infections among youth. The research is innovative in its application of rigorous implementation science methods and academic detailing in a novel context in urban pediatric settings. The research strategy directly aligns with Dr. Guss’ career development goals in behavior-change interventions for providers, qualitative and quantitative methods, and implementation science for PrEP. This K23 award will allow Dr. Guss to receive necessary training and experience to develop skills and knowledge in HIV prevention and implementation science. Dr. Guss is supported by an experienced and multidisciplinary mentorship team to help her achieve her research and training goals. Dr. Guss has assembled a scientific advisory board of national experts in HIV prevention for youth to provide additional guidance and feedback to ensure that this project and my scientific training are successful. Dr. Guss’ career goal is to become an independent clinician-investigator, and she will use the preliminary data obtained during this study to apply for NIH R01 funding in the final years of this award in pursuit of her career goal.