Launching Pediatric Primary Care-Based PrEP for Adolescents in a Low HIV Prevalence Setting.

OBJECTIVE: 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. METHODS: We conducted a qualitive 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 2021-2025 as this was the only reliable risk factor trackable in the electronic medical record, using a statistical process control chart. RESULTS: 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% to 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. CONCLUSION: 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.