# Boosting HIV Pre-exposure Prophylaxis (PrEP) Prescribing Confidence in a Southern Family Medicine Residency

## TL;DR

A short educational session improved family medicine residents' confidence in prescribing HIV prevention medication, PrEP, especially in rural and high-risk areas.

## Contribution

A low-resource educational intervention significantly boosted residents' comfort in prescribing PrEP despite minimal changes in knowledge.

## Key findings

- Residents' comfort in initiating PrEP increased from 30% to 72%.
- Residents' confidence in overall PrEP management rose from 35% to 62%.
- Limited knowledge and uncertainty about LGBTQ+ care were identified as barriers to PrEP prescribing.

## Abstract

Introduction: Pre-exposure prophylaxis (PrEP) is a highly effective pharmacologic strategy for preventing HIV infection, yet it remains underutilized, particularly in the southeastern United States and among adolescent populations. Family medicine physicians, especially those practicing in rural areas, are well-positioned to identify and manage PrEP-eligible patients, including adolescents and members of LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) communities. However, many providers report inadequate training in sexual health, LGBTQ+ care, and HIV prevention. This study aimed to assess the impact of a brief educational intervention on family medicine residents’ knowledge, attitudes, and skills in prescribing PrEP to a diverse range of high-risk individuals.

Methods: A one-hour educational session on PrEP was delivered at a rural-focused family medicine residency program in the southeastern US. Twenty residents completed pre- and post-intervention surveys consisting of true/false knowledge questions and five-point Likert-scale items assessing comfort with PrEP prescribing. Descriptive statistics and paired t-tests were used to evaluate change.

Results: While no statistically significant improvement was noted in knowledge scores (mean: 84.7% pre vs. 87.2% post, p = 0.108), participants reported notable increases in prescribing comfort. The proportion of residents who felt somewhat or extremely comfortable with initiating PrEP increased from six (30%) to 14 (72%), continuing therapy from seven (35%) to 14 (72%), and overall PrEP management from seven (35%) to 12 (62%). Eighteen residents (90%) identified limited knowledge as a barrier to PrEP prescribing, and several cited uncertainty about engaging LGBTQ+ patients in risk-based conversations.

Conclusions: A single, low-resource educational intervention can improve family medicine residents’ confidence in PrEP prescribing, despite minimal change in knowledge scores after this small-scale study. These findings underscore the importance of integrating sexual health, including prescribing PrEP for HIV, and LGBTQ+-inclusive training into residency education, particularly in high-need regions. Scalable educational models like this may help advance the Ending the HIV Epidemic in the US initiative by equipping primary care providers to engage more effectively in HIV prevention and address disparities among vulnerable populations.