Pediatricians' Discomfort With Pre-exposure Prophylaxis (PrEP) for HIV Prevention: The Need for Greater Education

Objectives Despite being at a heightened risk of HIV, the use of pre-exposure prophylaxis (PrEP) among adolescents remains low, which may stem from access to this biomedical intervention and the comfort of providers caring for this priority population. Prior studies evaluating the comfort and knowledge of providers related to PrEP have focused on adult providers or been conducted prior to FDA approval of PrEP for adolescents. This study focuses on pediatric providers' knowledge and comfort regarding counseling and prescribing PrEP to adolescents. Materials and methods Two anonymous surveys were administered to self-identified clinical providers treating pediatric patients at least part-time and practicing in Maryland in 2016 (n=118) and 2020 (n=60). General awareness, prior training, and personal clinical practice regarding PrEP were compared between respondent groups, as well as respondent self-reported comfort related to specific clinical scenarios to determine if pediatric provider knowledge and comfort have changed over time. Results General awareness of PrEP rose between the two surveys, with respondents reporting traditional education sources (continuing education, training, or colleagues) and non-traditional sources (television, the Internet, or social media). There was no change in self-reported comfort related to counseling and prescribing PrEP between the two surveys, and overall clinical knowledge remained low, with many respondents unable to identify necessary laboratory tests needed to begin medication safely. Conclusions Despite an increase in general awareness, provider comfort with PrEP did not increase over time. There is a need for ongoing education for pediatric providers to increase comfort and knowledge of biomedical HIV prevention to make it more readily available.