HIV PrEP and PEP in Graduate Medical Education: A Novel Curriculum

Abstract

BackgroundHIV pre-exposure prophylaxis (PrEP) is highly effective but underutilized. Medical trainees cite a need for additional PrEP training. We established a pilot curriculum focused on key PrEP and post exposure prophylaxis (PEP) components with these objectives: identify candidates eligible for PrEP/PEP; appropriate monitoring on treatment; STI screening of at-risk patients; treatments for common STIs. To our knowledge, this is the first description of a formalized curriculum for medical trainees in PrEP/PEP.MethodsThe Oval Center is a comprehensive sexual health clinic in Bronx, New York, focusing on STI and PrEP/PEP. Participant learners include internal medicine residents and I.D. fellows who choose the center as a 2-week clinical elective and/or additional continuity site. The curriculum is composed of 3 core components: 1) patient care, 2) didactics (2 sessions by ID faculty focused on practice guidelines), 3) directed readings (current treatment guidelines/seminal papers). Learners completed a pre- and/or post-training confidential questionnaire that assessed confidence in components of PrEP/PEP and STI care on a 5-point Likert scale.Results8 learners have completed the curriculum to date: 4 fellows and 4 residents. All learners reported high confidence in aspects of STI and PrEP care, for example, in conducting appropriate STI screening and treatment and recommending and monitoring patients on PrEP (median score 5). Preliminary pre-post analysis of 4 learners demonstrated the greatest increase in confidence in addressing health needs of the LGBTQ population (median Δ1.5), and recommending and monitoring patients on PEP (median Δ2)ConclusionThis pilot demonstrates that a curriculum focused on PrEP/PEP is feasible. Preliminary analysis demonstrates that learners had high confidence in prescribing PrEP/PEP and treating common STIs, although numbers were small. Plans to expand the curriculum are currently underway. Rigorous curriculum evaluation is ongoing, including pre-post analysis of all participant learners and evaluation of curriculum impact on behavioral outcomes, such as change in learners’ self-reported rates of PrEP prescribing. Prompt dissemination of this or similar models may help improve PrEP/PEP uptake and STI care for future providers.Disclosures All authors: No reported disclosures.