240 - "I Have No Idea What You're Talking About": A Pilot Study of Pediatrician Perspectives on Barriers to HIV Pre-exposure Prophylaxis

Publication Number: 3232.240

Carly Guss, Boston Children's Hospital, Chestnut Hill, MA, United States; R. Korkodilos, Boston Children's Hospital, Boston, MA, United States; Sabra L.. Katz-Wise, Boston Children's Hospital, Boston, MA, United States; Douglas Krakower, Beth Israel Deaconess Medical Center, Boston, MA, United States; Kenneth Mayer, The Fenway Institute, Boston, MA, United States

Background: Adolescents and young adults account for nearly 20% of new HIV diagnoses in the United States. HIV pre-exposure prophylaxis (PrEP) is 99% effective at preventing HIV when used as prescribed and is FDA approved for individuals weighing at least 35kg independent of age. However, pediatric primary care providers (PCPs) infrequently prescribe PrEP.

Objective: 1. To explore barriers and facilitators to PrEP discussions and prescribing among pediatric PCPs. 2. To identify educational needs of pediatric PCPs related to HIV PrEP.

Design/Methods: Pediatric PCPs were recruited from 4 primary care clinics at Boston Children’s Hospital during July 2025-October 2025 for a one-time qualitative interview. No prior experience prescribing PrEP was required to participate. In addition to demographics, participants were asked about sexual history taking, knowledge of PrEP, and preferences about learning medical information. Interviews were audio-recorded and transcribed verbatim. Using Braun and Clarke’s thematic analyses approach, two members of the team independently applied codes to sections of data and then collaboratively developed themes.

Results: Eleven physicians and 2 nurse practitioners were interviewed. Mean years of practice was 15.8 (SD=9.7). One participant (7.7%) had not heard of PrEP prior to the study, ten (76.9%) had previously prescribed PrEP, and eight (61.5%) had some education on PrEP, such as a single lecture. The majority (61.5%, n=8) were aware of injectable PrEP. Preliminary themes included need for increased education in sexual history taking, desire for electronic health records to support PrEP prescribing, and interest in learning to prescribe PrEP as a part of overall sexual health counseling. Lab monitoring and confidentiality concerns were noted as barriers to prescribing PrEP. Overall lack of provider familiarity with medications led to hesitancy in holding discussions and prescribing. PCPs expressed willingness to learn from webinars or teaching from a peer to improve PrEP knowledge.

Conclusion(s): In this pilot study, pediatric PCPs affiliated with a Boston academic medical center have limited formal PrEP education but are interested in learning more to become competent. PrEP education should focus on sexual history taking, basic PrEP prescribing and monitoring, and be delivered by peers. Interventions that address these gaps may improve PrEP implementation and impact in pediatric primary care settings.