Assessing Barriers in Obstetrics and Gynecology Trainee Knowledge and Prescribing of HIV Pre-Exposure Prophylaxis in a High-Risk Community

• Published in: Women's health reports (New Rochelle, N.Y.) N.Y.), 2024-10, Vol.5 (1), p.825-830
• Main Authors: Young, Anna Marie P., Berhie, Saba, Pedamallu, Havisha, Patterson, Lane, Yee, Lynn M.
• Format: Article
• Language: English
• Subjects: Original Article
• ISSN: 2688-4844; 2688-4844
• DOI: 10.1089/whr.2024.0123

Objective: To assess pre-exposure prophylaxis (PrEP) knowledge and prescribing confidence one year after implementation of an obstetrics and gynecology (OBGYN) resident curriculum and evaluate barriers to PrEP prescribing in an OBGYN resident clinic. Materials and Methods: This mixed methods study evaluated OBGYN residents who provide care in a high HIV prevalence city. Resident physicians, including those who did and did not participate in the original curriculum, completed a survey of knowledge and comfort prescribing PrEP; responses were compared with previously collected survey results from prior to and immediately after the curriculum. Second, we conducted focus groups and individual interviews ( n = 12 participants) to assess perceived barriers and areas for improvement in PrEP delivery. Transcripts were coded via Dedoose software and organized according to themes using a constant comparative approach. Results: The average score for the knowledge evaluation was 62.6%, which was lower than the immediate postcurriculum scores from one year prior (78.9%, p < 0.05). A significantly lower proportion of residents reported that they were comfortable with prescribing PrEP compared with the prior year (26.1% vs. 71.9%, p < 0.05). Only 56% of residents reported counseling a patient in clinic about PrEP, and 34% had reported prescribing PrEP 1-year postcurriculum. Qualitative themes regarding barriers to PrEP provision included knowledge, institutional, operational, and perceived low-risk population. Potential solutions for each barrier included department-wide and recurring education for all training levels, introduction of a PrEP monitoring pathway, implementation of nursing questionnaires, task lists, pretemplated texts, and increasing awareness of PrEP. Conclusion: Beyond educational deficits, several other operational and institutional barriers prevent the full inclusion of PrEP provision in an academic OBGYN ambulatory setting.