Adapting an Intervention to Improve Adolescent Sexual Health Assessment and Pre-Exposure Prophylaxis Prescription by Family Medicine Physicians in Alabama

Madeline C Pratt; Oluwaseyi O Isehunwa; Samantha V Hill; Tina Simpson; Robin Gaines Lanzi; Nicholas Van Wagoner; Brook A Hubner; Douglas Krakower; Tara E Wood; Latesha E Elopre; Lynn T Matthews

doi:10.1089/apc.2025.0064

Adapting an Intervention to Improve Adolescent Sexual Health Assessment and Pre-Exposure Prophylaxis Prescription by Family Medicine Physicians in Alabama

AIDS Patient Care STDS. 2025 Jul 8. doi: 10.1089/apc.2025.0064. Online ahead of print.

Affiliations

¹ Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
² Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA.
³ Department of Pediatrics, School of Medicine, Section of Adolescent Medicine, Tulane University, New Orleans, Louisiana, USA.
⁴ Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁵ Department of Medical Education, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁶ Departments of Medicine and Population Medicine, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

PMID: 40625125
DOI: 10.1089/apc.2025.0064

Abstract

High HIV incidence in the US South disproportionately affects adolescents, young adults, and Black women. Using a community-engaged approach and intervention mapping, we developed PrEP-Pro, an intervention to support family medicine physician-trainees to elicit a sexual history from and provide pre-exposure prophylaxis (PrEP) to adolescents, with special emphasis on engaging with Black adolescent girls and young women (AGYW). Intervention content includes PrEP curricula, adaptations to the Centers for Disease Control and Prevention (CDC)'s sexual history tool, and a PrEP Champion training program. Two community advisory boards (CABs)-one consisting of PrEP Champions and physicians, the other of AGYW-and two focus group discussions with physicians (N = 7) informed intervention content. We pretested PrEP-Pro at two sites over 3 months and assessed acceptability, appropriateness, feasibility. The provider CAB advised multiple training strategies: (1) locally informed sexual history videos; (2) HIV epidemiology review; (3) quick-reference badge and pocket cards on PrEP and eliciting sexual histories; (4) didactic, case-based content; (5) web-based content. The AGYW CAB informed development of (6) a sexual history screener and (7) clinic posters emphasizing confidentiality for adolescent clients. Across two family medicine residency programs, eight physicians participated in the 3-month pretest of the intervention. Acceptability (mean = 4.16/5 [standard deviation (SD) = 1.36]), appropriateness (4.16/5 [1.36]), and feasibility (4.19/5 [1.37]) were high. Six physician interviews informed adaptations including fostering a community of practice, increased case-based learning, and quick-reference card content modifications. We combined theory-driven and evidence-informed components to adapt and pilot PrEP-Pro to support physicians in discussing PrEP with adolescents. The adapted intervention was piloted across clinics to inform a future trial.

Keywords: HIV; PrEP; adolescents; family medicine; implementation science; residents.