Narrative/Abstract
Black adolescent girls and young women (AGYW) are at high-risk for HIV acquisition. Antiretroviral
medication for pre-exposure prophylaxis (PrEP) is an effective, female-controlled strategy to dramatically
reduce HIV-acquisition risk, but uptake is low. With funding from an Ending the HIV Epidemic (EtHE)
supplement to the UAB Center for AIDS Research, we surveyed and interviewed health care providers working
in Alabama. Our data suggest that providers do not consider prescribing PrEP to Black AGYW. Important
barriers include client, provider, and community stigma around sexuality, challenges of obtaining a sexual
history, limited training on PrEP indications and management, and structural limitations related to insurance.
Using the Intervention Mapping, and the Capability-Opportunity-Motivation-Behavior model for
behavioral change, we propose to adapt evidence-based curriculum on HIV epidemiology, PrEP indications
and efficacy; skills building and client-facing tools for obtaining sexual histories; and provider PrEP Champions
to create a multi-component context-specific provider intervention, PrEP-Pro. In Aim 1, we will adapt PrEP-Pro
to Family Medicine trainees due to their role in caring for adolescents at stages of transition and substantial
contributions to rural healthcare. We focus on residents in training to leverage trainee mindset and energy
while seeding the Family Medicine workforce with PrEP informed providers. We will convene an advisory board
of providers, PrEP Champions, AGYW, and clinic administrators to adapt existing content to the local context.
We will solicit feedback on PrEP-Pro content from providers and AGYW through focus group discussions. In
Aim 2, we will pre-test the adapted PrEP-Pro content with up to 12 Family Medicine residents and 2 PrEP
Champions in rural and urban AL and further hone PrEP-Pro based on their feedback via surveys and in-depth
interviews. We will then conduct an open pilot with 60 Family Medicine residents. Primary pilot outcomes are
acceptability and feasibility. We will also measure PrEP knowledge and attitudes as well as PrEP prescribing
patterns and HIV/STI testing in the 6-month periods pre- and post-intervention. In Aim 3 we will elucidate
determinants to PrEP-Pro implementation by conducting in-depth interviews with providers, AGYW, and other
key stakeholders, reviewing findings with our CAB, and seeking additional input through dissemination events
to inform a future hybrid effectiveness/implementation trial.
With expertise in adolescent health, sexual health, adult medical education, PrEP, qualitative methods,
community-engaged research, and intervention development and a team led by women and African-American
clinician-scientists who work, live, teach, and provide care in the Deep South, we are well-positioned to
complete the proposed science, disseminate information to key stakeholders and policy makers, and apply
these data to inform interventions to mitigate HIV for AGYW in the Deep South.