Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but prescribing rates remain low. We examined the effect of an educational intervention on PrEP knowledge and prescribing likelihood among medical residents.
This was a prospective study using a convenience sample of Internal Medicine and Internal Medicine-Pediatrics residents at a tertiary care center in Portland, Maine. Participants attended a resident-led teaching session on PrEP and completed pre and post-session surveys. PrEP knowledge was measured with 5 questions (definition, evidence, patient selection criteria, medication choice and guidelines), and prescribing likelihood was assessed on a Likert scale. Participants identified motivating factors and barriers to prescribing. Survey data were analyzed with McNemarÕs test or a paired studentÕs t test as appropriate.
Thirty residents completed the study; of these, 24 (83%) had at least 1 patient that they considered at high risk for HIV, and 14 (46%) reported having >5 such patients. None had ever prescribed PrEP.
Average PrEP knowledge score increased after the intervention (pre=2.33 vs post=4.1, p<0.001). After the intervention, more participants reported that they would be likely to prescribe PrEP (pre=76% vs post=90%, p=0.014), fewer identified unfamiliarity with PrEP guidelines as a barrier (pre=73% vs post=27%, p<0.001), and Òother residents are prescribing PrEPÓ became a significant motivating factor (pre=47% vs post=70%, p=0.04). Preceptor comfort with prescribing PrEP was a consistently important influence on prescribing likelihood (90% vs 82%, p=0.22).
Familiarity with PrEP is relevant to resident practice, and an educational intervention is effective in the short term for addressing inadequate knowledge as a barrier to offering PrEP. Resident practice is influenced by preceptors and peers, suggesting that it may be helpful to include attending physicians in future PrEP education efforts at our institution.
K. Thakarar, None