In 2020, adolescents and young adults (AYA) made up 20% of new human immunodeficiency virus (HIV) diagnoses in the United States (US).1 Among individuals ages 13 and older in the US, the overall rate of new HIV diagnoses was 10.9 per 100,000 individuals. The South has the highest overall rate of new HIV diagnoses at 14.7 per 100,000 individuals; Texas has a rate of 14.8 per 100,000 individuals.1 In Dallas County in 2019, there were 140 new cases of HIV diagnosed among 15-24 year olds.2 The 2019 Youth Risk Behavior Study (YRBS) shows that 42.7% of 9th – 12th graders in Texas had ever had sex and that 51% did not use condoms.3

Pre-exposure prophylaxis (PrEP) provides an opportunity to prevent new HIV infections among AYA. The first two drug combination tablet containing emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) (Truvada®) for oral PrEP was approved for adults by the Food and Drug Administration (FDA) in 2012 and for adolescents in 2018.4 Even with FDA approval, clinicians must be comfortable with sexual and reproductive health (SRH) counseling and prescribing relevant medications.

Key barriers to counseling about and prescribing PrEP include: lack of training, insurance concerns, adherence concerns, side effects, time constraints for counseling, monitoring requirements, worries that PrEP will promote HIV resistance if a person taking PrEP becomes infected with HIV, and a belief that PrEP might promote risk-taking behaviors like condomless sex.5, 6, 7 Specific barriers to prescribing to adolescents include sexual history taking, confidentially, and consent without parental involvement.8, 9 Many of these studies, however, were conducted and published prior to the FDA approval of PrEP for adolescents.

Residents and fellows in Pediatrics, Family Medicine, and Obstetrics and Gynecology (Ob-Gyn) are often the first healthcare providers to engage in discussions about sexual health with AYA at academic institutions. Previous studies of residents’ comfort with and knowledge of PrEP have specifically surveyed family medicine and internal medicine residents, with few including pediatric providers.6, 10, 11, 12 The American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology (ACOG) recognize the importance of confidential access to SRH services.13, 14 Comprehensive sexual history taking, HIV testing, and counseling about PrEP are included in guidance from the AAP and ACOG.14, 15 Across all physicians, only 9.3% of cisgender females eligible for PrEP received PrEP prescriptions, despite cisgender females representing 18% of new HIV diagnoses in 2020.1, 16

The 2021 CDC guideline recommends all sexually active adolescents should be informed about PrEP for prevention of HIV and be prescribed PrEP if risk factors are identified or if the patient desires.17 Despite these recommendations, pediatricians spend an average of 36 seconds on SRH counseling during adolescent health maintenance visits.18 This study sought to characterize when learners believed that one should receive training in PrEP and to describe confidence in prescribing PrEP among residents and fellows in Pediatrics, Ob-Gyn, and Family Medicine.