Integrating PrEP Into Primary Care for Adolescents

Statement of Problem

In May 2018, the U.S. Food and Drug Administration approved HIV pre-exposure prophylaxis (PrEP) for use among adolescents. An essential tool in ending the HIV epidemic, PrEP is a daily pill that is more than 90% effective in preventing HIV infection in users with high adherence. Despite disproportionally high rates of HIV infection among adolescents and young adults and the U.S. Preventative Service Task Force’s “Grade A” recommendation for PrEP in primary care, PrEP uptake in youth has been poor.

Guidelines recommend delivering PrEP within a package of preventive services including sexually transmitted infection (STI) screening and risk reduction counseling. Key barriers to expanding PrEP uptake for youth are the lack of evidence-based behavioral interventions to promote its use and strategies for how to best implement PrEP in pediatric health care systems. Most adolescents receive their sexual health services in pediatric primary care, including testing and treatment of STIs. These sexual health care encounters provide a window of opportunity for delivering effective HIV prevention interventions when youth are more motivated for behavior change.

Unfortunately, delivery of sexual health services in primary care is hampered by limited time and clinical knowledge. Within busy primary care practices, pediatricians often need to address a wide range of issues including mental health. Given the demands placed on primary care providers, there is a critical need to develop theory-based, PrEP-inclusive, HIV prevention interventions for youth that we can effectively and efficiently integrate into primary care.

Description

Integrating PrEP Into Primary Care for Adolescents

STI testing; HIV; pediatricians; sexually transmitted infections; prevention
STI testing; HIV; pediatricians; sexually transmitted infections; prevention

By convening both teens and health care system experts, we hope to understand how to best address the sexual preventative health needs of teens.

Since evidence shows that STI and HIV prevention aren’t “one size fits all,” our goal is to allow youth to identify their own prevention goals at the beginning of the intervention, such as starting PrEP or using condoms consistently, and then measure their progress toward meeting that goal throughout the intervention. By using health coaches—individuals who are trained in motivational interviewing and sexual and reproductive health—we can move the heavy lift of safer sex counseling off of over-burdened primary care providers.

Through this project, we will conduct focus groups with adolescent primary care patients and interviews with primary care providers. By convening both teens and health care system experts, we hope to understand how to best address the sexual preventative health needs of teens while making an efficient workflow for primary care providers.

We will test the effectiveness of our intervention in improving PrEP uptake and reducing STI infections in adolescents by conducting a randomized controlled trial of a health coaching intervention in adolescents attending primary care. At the end of the six-month intervention, we will measure STI re-infection rates, HIV and STI testing rates, and PrEP uptake to see if youth have achieved their safer sex goals.

Next Steps

Our ultimate goal of this five-year program is to develop a behavioral intervention to improve PrEP use in adolescents and understand from providers the best way to integrate the intervention into our busy primary care practices. By tailoring STI and HIV prevention interventions to fit the needs of both youth and primary care providers, we hope to build an intervention that can move beyond our own clinics at Children’s Hospital of Philadelphia and into the broader world of adolescent primary care.

This project page was last updated in March 2020. 

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Integrating PrEP Into Primary Care for Adolescents [Online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here]. 

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