Launching Pediatric Primary Care-Based Pre-Exposure Prophylaxis for Adolescents in a Low Human Immunodeficiency Virus Prevalence Setting

The objective of this Quality Improvement (QI) initiative was to increase the provision of HIV pre-exposure prophylaxis (PrEP) care in pediatric primary care clinics, among adolescents at risk for HIV.

We conducted a quality improvement initiative in 22 pediatric primary care clinics in southeast Wisconsin. After identifying barriers via provider survey, we implemented a multicomponent intervention bundle in 2023, including PrEP clinical guidance, provider education, long-acting injectable PrEP availability, best practice alerts and infectious disease electronic consultation for all PrEP-eligible adolescents. For the primary outcome we utilized PrEP prescription rates among adolescents diagnosed with a bacterial sexually transmitted infection (STI) from 2021 to 2025 as this was the only reliable risk factor trackable in the electronic medical record, using a statistical process control chart.

Among surveyed pediatric primary care providers, 93% had never prescribed PrEP, with lack of awareness and discomfort being major barriers; a targeted educational intervention significantly increased provider comfort discussing and offering PrEP (from 36% to 100%, p<0.01). Following implementation of a multicomponent QI bundle, PrEP initiation among adolescents with a bacterial STI rose from <1-5%. 96% of patients who started PrEP received guideline-concordant care. Injectable cabotegravir was selected by 43% of new PrEP users, and most care remained within primary care.

This QI initiative successfully launched adolescent PrEP care in primary care through provider education, clinical guidance, and multidisciplinary support, demonstrating feasibility of improving HIV prevention even in low prevalence settings.