Abstract
Objectives
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool, yet uptake among women remains low, particularly for Black cisgender women. We aimed to identify determinants of PrEP implementation in OB/GYN residency clinic settings and develop an OB/GYN training program for a combined-care PrEP model in preparation for pilot testing.
Methods
We conducted a qualitative descriptive study using semi-structured, CFIR-guided qualitative interviews with OB/GYN residents, OB/GYN residency faculty, and PrEP providers in New Orleans, Louisiana. We then presented the findings in provider working group sessions to obtain feedback on the training program and adapt the program based on suggested modifications.
Results
We conducted 12 interviews and 2 working group meetings. Participants perceived OB/GYN residents would be highly compatible PrEP providers given their focus on sexual health. They also identified provider barriers including limited knowledge, time constraints, and care discontinuity due to resident rotation blocks. Working group providers emphasized the need for practical training resources, clear clinical protocols, and a designated PrEP champion.
Conclusion
Participants and working group providers viewed OB/GYN resident clinics as an acceptable setting for implementing and piloting a PrEP program. We finalized the scalable, provider-informed training model—“Start the Conversation”—to support PrEP integration into routine OB/GYN care at resident clinics.
Keywords: HIV prevention, pre-exposure prophylaxis, prep, OB/GYN residents, implementation science, qualitative research, provider training, Black women, cisgender women
Plain Language Summary
HIV prevention medicine, called PrEP, can prevent HIV very effectively, but many women, especially Black women, are not using it. One reason is that PrEP is often discussed in HIV clinics, while many women get most of their healthcare from their OB/GYN doctor. OB/GYNs are trusted providers for sexual and reproductive health, but many do not receive training on how to talk about PrEP or prescribe it. This study looked at how PrEP could be better offered in OB/GYN clinics. We interviewed OB/GYN residents (doctors in training), OB/GYN leaders, and HIV/PrEP providers to understand what would make it easier or harder for OB/GYN clinics to offer PrEP to women. We also held meetings with OB/GYN providers to design a training program based on what we learned. Providers told us that OB/GYN clinics are a good place to talk about HIV prevention because they already discuss sexual health. However, they also described challenges, including short visit times, lack of PrEP knowledge, and difficulty following up with patients. Together, we used this information to create a training program that teaches OB/GYN residents how to start conversations about PrEP, prescribe it safely, and connect patients to follow-up care when needed. This work shows that OB/GYN clinics can play an important role in HIV prevention for women when providers are given the right training and support.
Introduction
PrEP (pre-exposure prophylaxis) is a highly effective HIV prevention tool, yet its uptake among cisgender women, particularly Black cisgender women (hereafter “Black women”), remains critically low. In the United States, Black women experience a disproportionate HIV incidence and account for a significant fraction of new infections; paradoxically, women in the US account for only 8% of PrEP prescriptions. 1 Research and public health reports highlight structural obstacles, for example, concerns about cost and fragmented healthcare access, that impede women’s ability to obtain PrEP.2,3 Additionally, many women have low HIV risk perception and limited PrEP awareness, often due to the absence of relatable public health messaging for women.4-7 Stigma and medical mistrust further deter PrEP use.8-10
Obstetrics and gynecology (OB/GYN) clinical care settings represent a pivotal yet underutilized opportunity to address these disparities and potentially overcome such barriers. OB/GYN physicians often serve as primary or sole healthcare providers for many women, especially those without a dedicated primary care provider. 11 Women tend to trust their OB/GYNs for sexual and reproductive health needs, 12 and this trust can offset stigma and open the door to PrEP discussions in an environment where patients already seek sexual healthcare. 13 Encouragingly, the American College of Obstetricians and Gynecologists (ACOG) guidelines recommend discussing PrEP with all sexually active patients, 14 aligning with updated guidance from the Centers for Disease Control and Prevention (CDC). 15
Our prior qualitative research with Black women in New Orleans, LA, revealed that providers are not discussing PrEP routinely with Black women. Black women participants noted that if they were to have these discussions, they would want them to be with their sexual health or OB/GYN providers. 4 However, significant obstacles impeding the integration of PrEP services into OB/GYN settings have been reported, with lack of education and infrastructure to support prescribing identified as major barriers. 16 Efforts have been undertaken to enhance PrEP knowledge among OB/GYN providers, including the development of training guidance and programs.17-19 Additionally, there has been some focus on the training of residents, a logical group to target for PrEP training, as they are in a learning phase of their careers and actively developing their clinical practice patterns. Two preliminary studies have assessed the impact of a one-time training, finding that it enhanced PrEP knowledge and comfort with PrEP prescribing.20,21 However, a third study evaluated PrEP prescribing one year following implementation of a PrEP training curriculum, finding that knowledge and comfort decreased in the postcurriculum time period. 22
The current study describes our process to develop a PrEP training program for OB/GYN residents in New Orleans, LA, where 82% of women newly diagnosed with HIV are Black. “Start the Conversation” (R34MH129211) is a multi-level intervention developed by our investigative team of community and academic partners that involves 1) an OB/GYN resident training program, and 2) a social media campaign to raise awareness about PrEP among Black women (described elsewhere). The development of the OB/GYN training component of “Start the Conversation” incorporated qualitative data from provider interviews as well as feedback from provider working group sessions, as described below.
Methods
Study Design and Data Collection
We first implemented a qualitative descriptive study to identify determinants of PrEP implementation in OB/GYN residency training settings. 23 We conducted one-on-one, semi-structured in-depth interviews with participants from three stakeholder groups: (1) OB/GYN residents (trainees in obstetrics and gynecology who could initiate PrEP discussions and prescribe PrEP in clinic), (2) OB/GYN residency program faculty and leadership (including attending physicians, clinic directors, and residency program leadership overseeing clinical care and training), and (3) PrEP clinic providers (advanced practice providers or primary care providers working in dedicated PrEP clinics or whose clinical work was primarily dedicated to PrEP prescribing). We used purposive sampling to select participants: OB/GYN residents and faculty must have been associated with the participating OB/GYN residency program or affiliated faculty; for PrEP providers, selection required active PrEP prescribing practice at clinics in New Orleans. We recruited OB/GYN residents through the residency program director, who circulated recruitment messages. OB/GYN faculty and leadership were recruited through direct invitation by one of the study’s principal investigators (PI), based on their clinical and administrative roles. We recruited PrEP providers through one of the PI’s professional networks based on their known focus on PrEP clinical care. This study was conducted in New Orleans, Louisiana, and data were collected from April 2022 through January 2023, encompassing the in-depth interview period (April–August 2022) and two subsequent provider working group sessions (September 2022–January 2023). Eligible participants were adults (≥18 years) in one of the three stakeholder roles described above who were affiliated with the participating OB/GYN residency program (residents and faculty/leadership) or actively prescribing PrEP at a New Orleans clinic (PrEP providers), and who were able to complete an interview in English. Individuals who did not meet these role-based criteria, or who were unable or unwilling to provide verbal agreement to participate, were excluded.
During the interviews, we described the proposed OB/GYN PrEP program, initially introducing our “combined care model” in which residents would receive training on PrEP in order to 1) initiate PrEP discussions or “Start the Conversation” with women, 2) prescribe PrEP for those who expressed interest, and 3) engage women in a shared decision-making process about where they would like to receive PrEP follow-up care – at the OB/GYN resident clinic or a local PrEP clinic. The interview guide was informed by the Consolidated Framework for Implementation Research (CFIR) and was designed to capture perspectives across multiple CFIR domains (see supplement for question guide). The interview guide was developed by the study team specifically for this study and was not a previously validated instrument; it was informed by the CFIR and refined iteratively by the investigative team prior to data collection but not formally pilot tested. Questions related to the Outer Setting explored provider perceptions of HIV prevention needs among Black cisgender women and external factors influencing PrEP uptake, including stigma and access barriers. The Inner Setting domain focused on current sexual health and HIV prevention practices within OB/GYN clinics, organizational culture and resources, and how PrEP provision might fit within existing clinical workflows. Questions addressing Intervention Characteristics elicited feedback on the “Start the Conversation” intervention components, including compatibility with current practice and complexity of implementation. The Characteristics of Individuals domain examined providers’ knowledge, attitudes, and self-efficacy related to PrEP, including comfort discussing sexual risk and familiarity with PrEP medications and guidelines. Finally, questions aligned with the Process domain explored perspectives on implementation processes, primarily training. Our sampling approach was guided by the concept of information power, which considers the specificity of the research aim, sample specificity, quality of dialogue, and the analytic strategy, ultimately focusing on data sufficiency rather than saturation. All interviews were conducted by a member of the study team, audio-recorded with permission, transcribed verbatim, and lasted approximately 30–60 minutes. Accordingly, thematic saturation was not the explicit objective guiding recruitment, and we did not formally assess whether saturation was reached; we recognize this as a limitation of the study.
Following a rapid analysis of the interviews, 24 we conducted two in-person provider working group sessions with OB/GYN leadership and residents to inform the OB/GYN resident training program. During the first meeting, we presented the rapid analysis interview findings and gathered insights for integrating PrEP into women’s health settings. After developing the draft training program, we held a second provider workgroup to present the draft training plan and gather feedback and suggestions for successful implementation of the intervention. We then finalized the OB/GYN training component of the “” the Conversation” initiative and prepared for the pilot.
Data Analysis
For the formal analysis, we used applied thematic analysis to analyze the interview narratives. 25 We developed a codebook using the five 2009 CFIR domains (characteristics of individuals, inner setting, innovation characteristics, outer setting, and process) and expanded it with additional deductive codes to capture selected associated constructs within each domain, which were based on key insights from a rapid analysis of interviewer debriefing notes. Two analysts independently coded each transcript using NVivo, memoing key insights and meeting periodically to ensure inter-coder reliability. Coding discrepancies were resolved through discussion, and the codebook was refined iteratively. Next, narratives were reviewed under their respective CFIR domains/associated constructs to identify commonalities and patterns. We distilled several themes within each CFIR domain, representing the prominent determinants of intervention implementation. Representative quotes were extracted to illustrate each domain.
Statistical Analysis
This was a qualitative study, and no inferential statistical testing was performed. Participant demographic characteristics (Table 1) were summarized using descriptive statistics (frequencies and proportions) and are reported only at the aggregate level to protect participant confidentiality. Analysis of the interview data was conducted qualitatively using applied thematic analysis, as described above.
Table 1.
Demographic Characteristics
| Characteristic | Total N=12 n (%) |
|---|---|
| Age | |
| 28-29 | 3 (25.0) |
| 30-34 | 2 (16.7) |
| 35-39 | 0 (0.0) |
| 40-44 | 2 (16.7) |
| 45-49 | 3 (25.0) |
| 50-54 | 0 (0.0) |
| 55-57 | 2 (16.7) |
| Gender identity | |
| Cisgender male | 5 (41.7) |
| Cisgender female | 7 (58.3) |
| Ethnicity | |
| Hispanic or Latina/o/x | 1 (8.3) |
| Not Hispanic or Latina/o/x | 11 (91.7) |
| Race | |
| Black or African American | 2 (16.7) |
| White | 8 (66.7) |
| Another race | 2 (16.7) |
| Affiliated healthcare facility | |
| ID or PrEP clinic affiliated with a hospital | 2 (16.7) |
| ID or PrEP clinic not affiliated with a hospital | 2 (16.7) |
| OB/GYN clinic affiliated with a hospital | 8 (66.7) |
| Years in role 1 | (N=8) |
| Less than one year | 0 (0.0) |
| 1 to 2 years | 2 (25.0) |
| 3 to 4 years | 1 (12.5) |
| 5 to 10 years | 3 (37.5) |
| More than 10 years | 2 (25.0) |
| Previously provided a PrEP prescription 2 | (N=4) |
| Yes | 1 (25.0) |
| No | 3 (75.0) |
| Previously referred a patient for PrEP services 2 | |
| Yes | 3 (75.0) |
| No | 1 (25.0) |
1Asked to OB/GYN Leadership and PrEP Providers only.
2Asked to OB/GYN Residents Only.
The two Institutional Review Boards associated with this study (protocol numbers)[ Details provided in title page]. We were therefore not required to obtain informed consent (written or oral). However, we provided an informational sheet describing the purpose of the interviews and related information (e.g., risks) to all individuals during the recruitment process. The reporting of this study was informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see supplement for a completed COREQ checklist). The reporting of this study conforms to the Consolidated Criteria for Reporting Qualitative Research (COREQ) statement 26 (see Supplemental File for the completed COREQ checklist).
Results
In-Depth Interviews
We interviewed 12 participants: 4 OB/GYN residents, 4 OB/GYN faculty and residency leadership, and 4 PrEP prescribers from April to August 2022. We refer to OB/GYN residents, faculty, and leadership as OB/GYN providers throughout the results section and specify participant titles/positions when relevant. In addition, PrEP prescribers are referred to as PrEP providers. Participant demographic characteristics are provided in Table 1 (we present aggregate-level data only to protect participant confidentiality). Below, we describe the main thematic categories within each CFIR domain and include illustrative quotes in Table 2.
Table 2.
CFIR Construct and Participant Quotations
| Construct/Theme | Quotes |
|---|---|
| Outer Setting: Patient Needs, Barriers, and Community Context | |
| Low Perceived HIV Risk and PrEP Awareness Among Patients | Some…people are otherwise pretty healthy and not taking regular medicine and they’re not thrilled about the idea of taking a medication every day. I think that’s kind of a big one. A lot of… people in their young twenties, they just don’t love the idea of taking a pill every day… women in general just don’t see PrEP as something that they need. I think it’s still largely seen in the larger community as for gay men… I think a lot of it is under-identification of their HIV risk, not understanding that living in a high prevalence area is your big risk factor… (PrEP Provider) |
| I’ve noticed in New Orleans, at least, is that when we look at people, the general definition of who we would consider high risk for HIV, there are times when cisgender, Black women fall through those cracks. Because a lot of the patients that I’ve talked to about PrEP, at first, they know they just have one partner… And I ask, “Does that partner have additional partners?” And they often say, “I don’t know. I don’t know if my partner has additional partners.” And the patients that I have in my HIV clinic, who otherwise probably wouldn’t qualify as high risk, it was a similar situation how they were exposed to HIV. (PrEP Provider) | |
| Stigma and Trust as Key Influences of PrEP Engagement | The stigma regarding HIV in the African American community is horrible – it’s horrible down here. I think that’s our main problem in the south is the stigma. (PrEP Provider) |
| It’s hard for me to educate. I have to win their trust. And that’s especially hard in a resident clinic where they’re seeing multiple different residents. So, that’s definitely a particular challenge… because you have to have that continuity of care, and that’s just hard in our clinics. Oftentimes,…women are seeing different provider for every OB visit, for every GYN visit. And every year, they’re seeing somebody new. (OB/GYN Resident) | |
| Inner Setting: Clinic Environment and Organizational Readiness | |
| PrEP Discussions Compatible with Existing Practices | I absolutely think it’s appropriate for us to be talking about it in our clinic…oftentimes, we are the only provider that they see. A lot of our women who come in don’t have a primary care doctor…we may be the only touchpoint they have for healthcare. (OB/GYN Leadership) |
| I think people are more comfortable talking to their GYN about those things, maybe their primary care physician, like an internist or something. But that’s the nice thing about being a gynecologist because I think people coming in already know that that’s probably going to be a discussion. Whereas when you walk into a cardiologist, you know they’re going to ask about diet, exercise, those type of things. So, it’s kind of similar. People walk into the gynecologist, they’re going to be like, they’re going to ask about my periods. They’re going to ask me about sex. They’re going to ask all these kind of sensitive topics. So, there’s already a preparation, a mental preparation there. So, the door is slightly open. (OB/GYN Resident) | |
| Insufficient Time and Clinic Workflow Constraints | I think the biggest part of it is the sheer number of patients and the time that we’re allotted. And, (we’re) just trying to kind of rush through to get to the next one. It’s sad to say, but it’s not something new that I’ve thought about. It’s something we kind of deal with on a daily basis. It’s because we have so many patients that need care and so many women that need to be seen, that it just kind of rushes most conversations throughout all of our clinic visits. (OB/GYN Resident) |
| We are in desperate need for some kind of nurse navigator that is in charge of all things administrative or getting them plugged in with financial things. This would kind of fall into their role. But so many times, we refer…patients to things, and then it’s just kind of like, here you go. There’s really not a lot of time, opportunity, resources to do it. So, I don’t know. That’d be really hard. (OB/GYN Resident) | |
| The only thing that I would say is the continuity piece because the residents will [rotate] every so often – so if the patient does follow up…I think everybody needs to be on the same page with their knowledge and understanding about it in terms of refilling the medication and different things like that. That’s the only challenge I would see is just the lack of a true continuity because of kind of the nature of the resident schedule. (OB/GYN Leadership) | |
| Supportive Existing Infrastructure and Leadership | We are all in the same building [PrEP Provider and OB/GYN resident clinic], and I think that we can communicate through Epic if we have any other questions. And they can always send us an inbox message. “Hey, we have this patient. We’re initiating this patient on PrEP. Can you schedule them for a follow-up visit in a month, or whatever?” So, we have ways of communicating. (PrEP Provider) |
| I think our residents want to be able to do it. I think that we as attendings want to be able to teach it. I think that we want to make sure our patients are receive the best care possible. And so, I think that that’s the desire. If we really want to give our patients [the best care], then we have to be offering this, and we have to make it as easy as possible for them to get it. (OB/GYN Leadership) | |
| I think it is in line with the priorities of the institution, which is to reduce healthcare disparities, increase access to care…I do think it’ll be supported. (OB/GYN Leadership) | |
| Characteristics of Individuals: Provider Knowledge, Attitudes, and Self-Efficacy | |
| Limited PrEP Knowledge and Training Gaps | Like, they [residents] know a little bit about it [PrEP]. They’ve heard about it. They know some of the ins and outs of like, who’s a good candidate for it. But, I don’t think it’s something that is at the forefront of what they’re thinking…It’s not something that we tend to kind of discuss…So, I put it on myself and my colleagues at the clinic. I don’t think that we do a good enough job teaching that. So, if we don’t teach it, then how are they going to feel comfortable knowing?…how are you going to know to discuss that with the patient, or even to know who’s a candidate for it? (OB/GYN Leadership) |
| I don’t think I feel comfortable enough yet. I think that I can probably tell them what PrEP is from a very elementary standpoint. But, I think if you get into the nitty-gritty of what it does and how it works and you know, why we prescribe it, I think I would be stumbling on my words, you know, describing what it actually does. (OB/GYN Resident) | |
| …I also think that because faculty aren’t super comfortable administering or counseling about PrEP, we forget to ask the residents, right? Because the residents ultimately have to check out to us. So, I think that there’s a two-way street on that. The residents understand it, and realize we have a very at-risk population, but just forget. I think they just forget, because it’s not posted in the clinic. It’s not something we do on a regular basis, that I really just think it’s about consistency of, “Hey, did you do PrEP education? Does this patient qualify?” And I think if we were all better at that, we would probably see a really big uptake at least in the education of the patients who need it. (OB/GYN Leadership) | |
| Positive Attitudes Toward Sexual Health Discussions | I think it [discussions about sexual health] depends on the resident and their level of training. I think that our incoming interns are a little bit less comfortable with it, and it takes time for them to get used to that. And as you go through residency and talk to more and more patients, it becomes so routine that you have no hesitation at all. But it’s something that they learn. I think a lot of them don’t come into residency necessarily really comfortable with it. (OB/GYN Leadership) |
| We’re gynecologists. It’s what we do. If you were talking to a medicine resident, then maybe, but this is what we do, so I think they’re very comfortable taking a sexual history. (OB/GYN Leadership) | |
| They’re very comfortable because we’re with GYN. All of it is pretty sensitive stuff, so talking about intercourse or sexual partners it’s part of the job. (OB/GYN Resident) | |
| Intervention Characteristics: Perceptions of the “Start the Conversation” Strategy | |
| “Starting the Conversation” (Initiating PrEP Discussions with Patients) | I think it fits in really nicely because we’re already talking about STIs, and STI testing, and your risks, and all that. So, that’s already such a huge part of what we do during just our Well Woman. (OB/GYN Resident) |
| I think a script to kind of start the conversation. And it can be a living document. So, you may tweak it so that it sounds more like you, but at least they have a format…I think having those team-based learning scenarios where you’re kind of living out loud and practicing it because it just takes the anxiety out of it. The more you do, the less you’re anxious about having that conversation. And the more patients that you see, the more comfortable. So, I think having the appropriate number of patients, having something scripted, or even having some team-based learning activities to kind of help you navigate those different scenarios, and getting feedback about it. (OB/GYN Leadership) | |
| Prescribing PrEP | I don’t think it would be difficult, as long as like I said availability. Especially knowing the pharmacy that we have downstairs. As long as they have the supplies, I should be able to just prescribe it and they could either pick it up downstairs or as I said, we do clinic-administered injections for our patients all the time. So, it should be pretty easy. (OB/GYN Resident) |
| We have Epic. It’s an electronic medical record, and so prescriptions are fairly easy. They’re electronic. (OB/GYN Leadership) | |
| The Combined-Care Model for PrEP Monitoring and Follow-up | For example, commonly we do this for the Gardasil vaccine or Depo-Provera, which is contraception…they usually come, get their shot, leave, they’re done. So, this PrEP could be like that in the order set to be like that. It automatically – the order’s already in every two months and they come in and get their shot.. it is – it’s reasonable, it’s doable. I think that’s the biggest risk would be in the monitoring portion of it…(OB/GYN Leadership) |
| You could do a telehealth visit every three to six months and as long as everything looks good, it would be a very quick visit. It would take five minutes max. (OB/GYN Resident) | |
| Starting it then [i.e., during the GYN visit], and then referring them to a PrEP clinic, I think would be great. Having them come back to the GYN clinic is hard…So, being able to offer same-day appointments…They need to be referred to someplace that’s going to be flexible enough to see them when they can make it in. (PrEP Provider) | |
| I would welcome that [referral to PrEP clinic]. You know knowing that hey, we at least captured a patient who was high-risk and wanted these services we were able to initiate it. And then they’re getting follow-up care with someone who knows more about it than I do. I would welcome it. (OB/GYN Resident) | |
| Process | |
| Training | We could have it as part of our didactics that we do, and have a separate session for all the residents. We could have a few rotation-specifics that we give them some education at the very beginning of their, say, ambulatory clinic rotation. We could…do a combination of both would be good: Presenting it to the entire residency program, discussing what it's all about, giving them all the information. But then also, at the beginning of their rotation, give them more of the specifics of, “Okay, this is the order that you need to put in. This is what’s going to happen if they follow up with us.” (OB/GYN Leadership) |
| For us, our protected education time is on Friday afternoons. So, we can figure out a slot in that afternoon to do teaching with a group. That would be more of a resident didactic type of a thing. I had kind of thrown around the idea of actually coming into the clinic on a more frequent basis, and educating the residents in real time. I think that’s a great model… When you’re in the space that you’re providing the care, things just I think click more. And, it’s a shorter timeframe too. I think a 45-minute lecture’s great, but then what are you actually taking away? This would be more about, “Hey, here’s 5 – 10 minutes about PrEP.” Let’s talk about how we do it. And, I think if it’s an education combined with logistics in the clinic, that’s always more successful. And, I think anytime you see the residents, they’re happy too, which is always great. (OB/GYN Leadership) | |
Outer Setting: Patient Needs, Barriers, and Community Context
Low Perceived HIV Risk and PrEP Awareness Among Patients
Overall, both OB/GYN and PrEP providers described that a fundamental barrier, in their opinion, is patients’ limited awareness of HIV risk and the relevance of PrEP to them. They shared their perspective that many Black women seen in the clinic do not see themselves as at risk for HIV. They perceived that this low-risk perception means that women would be unlikely to initiate conversations about HIV prevention with their providers on their own.
Stigma and Trust as Key Influences of PrEP Engagement
PrEP providers said they suspected that HIV-related stigma and fear of judgment by providers were real concerns for patients. They perceived that Black women may hesitate to ask about or accept PrEP due to worry that it could trigger negative assumptions. Additionally, OB/GYN providers pointed out that the transient nature of resident rotations could impede trust-building and described this as a challenge inherent in their OB/GYN training program. However, they also said that the establishment of trust in the patient-provider relationship would serve as a powerful facilitator.
Inner Setting: Clinic Environment and Organizational Readiness
PrEP Discussions Compatible With Existing OB/GYN Practice
Both OB/GYN providers believed that introducing PrEP counseling in OB/GYN clinics is compatible with current care routines. They explained that sexual health (e.g., discussions about contraception, sexually transmitted infections [STIs]) is already a common topic during GYN visits, providing a natural segue into HIV prevention. Many OB/GYN providers suggested that OB/GYN residents should provide education on PrEP. Additionally, OB/GYN providers said that the high prevalence of STIs observed in the clinic population keeps them alert to sexual risk and thus primed to discuss HIV prevention. They explained this perceived fit with the clinic’s mission and norms was a facilitator, and that talking about PrEP would “make sense” in the context of comprehensive women’s health care. OB/GYN providers also elaborated that the OB/GYN clinic was an advantageous setting to reach women for HIV prevention, given that patients are regularly engaged there.
Insufficient Time and Clinic Workflow Constraint
OB/GYN providers expressed that the reality of clinic workflow poses challenges. They explained that OB/GYN clinics in this setting are high-volume and fast-paced, with short appointment slots. OB/GYN providers conveyed that intense time pressures and limited staffing would make it difficult to add new counseling topics. Another operational barrier frequently mentioned was lack of care continuity: because residents rotate frequently through different services, OB/GYN providers explained that the same provider may not see the patient at follow-up. They were also concerned that without a system to bridge these gaps, patients started on PrEP might “fall through the cracks” in between providers. High patient load and clinic overbooking were also mentioned as stressors that could limit providers’ ability to take on extra tasks like extensive counseling or proactive follow-up phone calls. OB/GYN providers felt that successfully implementing the PrEP intervention would require workflow adjustments, such as dedicating certain visit types or times for PrEP counseling, or additional support staff to ensure patients receive the necessary attention.
Supportive Existing Infrastructure and Leadership
The EHR system (Epic) was cited as a valuable tool as it already provides health maintenance prompts and allows for easy ordering of labs and medications. OB/GYN providers felt that the use of EHR to facilitate PrEP prescribing would integrate well with their workflow, ensuring necessary labs, such as HIV, STI, renal function tests, were not overlooked when prescribing PrEP. PrEP providers also emphasized that being within the same electronic health record would enable access to shared laboratory results, which they viewed as important for maintaining continuity and coordination of care. OB/GYN faculty and leadership shared their support for implementing PrEP, viewing it as aligned with their institutional goals to improve women’s health services.
Characteristics of Individuals: Provider Knowledge, Attitudes, and Self-Efficacy
Limited PrEP Knowledge and Training Gaps
OB/GYN providers, including residents, faculty, and leadership, stressed that they and other OB/GYN providers currently have insufficient knowledge and experience with PrEP, which they believe affects their confidence in prescribing it. OB/GYN providers acknowledged knowledge gaps, especially regarding newer aspects like injectable PrEP and detailed prescribing protocols. Most OB/GYN providers felt there was a need for PrEP training, including training on available formulations and eligibility criteria. OB/GYN providers expressed their interest and willingness to learn, highlighting that the barrier is knowledge and not motivation. No OB/GYN provider voiced moral reservations or disbelief in PrEP efficacy, and all said they viewed it as an important addition to women’s preventive care.
Positive Attitudes Toward Sexual Health Discussions
Most OB/GYN providers said they felt personally comfortable discussing sexual health topics with patients. All OB/GYN residents reported that they routinely ask patients about sexual partners and practices as part of their history-taking. OB/GYN leadership, however, suggested that junior residents may initially be less adept at sensitive conversations until they gain experience, and said that confidence in sexual health communication builds over time.
Intervention Characteristics: Perceptions of the “Start the Conversation” Strategy
“Starting the Conversation” (Initiating PrEP Discussions With Patients)
OB/GYN and PrEP providers voiced strong support for proactively introducing PrEP during OB/GYN visits. Providers felt this approach could normalize PrEP for women and take advantage of the routine GYN visit, reaching women who might not otherwise seek HIV prevention. Many suggested having simple scripts or prompts to help providers introduce PrEP in a non-judgmental, efficient manner. They recommended incorporating role-play and simulations and advising on scenarios such as initiating a conversation about HIV risk with a patient who doesn’t perceive her risk. OB/GYN providers also suggested preparing patients even before the provider enters the room might make patients more receptive when the provider brings it up. Despite their enthusiasm, they also said they worried about residents having enough time to fully counsel interested patients. However, most saw this initial “Start the Conversation” component as feasible with minimal adaptation: a checkbox or flag in the EHR could remind providers to mention PrEP for eligible patients, and providers could use brief motivational interviewing techniques, skills they already use for contraception counseling, to engage patients in deciding about PrEP.
Prescribing PrEP
OB/GYN and PrEP providers said residents would need clarity on required labs and eligibility criteria, particular medications used and dosing details, and potential side effects and management strategies. They suggested that the EHR could be configured to automatically display the appropriate labs when a PrEP order set is opened. OB/GYN providers also requested information on how patients can pay for PrEP and the presence of any financial assistance programs or navigational support.
The Combined-Care Model for PrEP Monitoring and Follow-Up (Shared Decision-Making Approach to Discuss PrEP Follow-Up at the OB/GYN Clinic or PrEP Clinic)
OB/GYN and PrEP providers said they supported the combined-care model including both follow-up pathways proposed, as it was practical and beneficial if executed well. They also expressed hesitation about the challenges of providing PrEP follow-up in a high-volume clinic where residents frequently rotate on and off. If they were to provide follow-up, OB/GYN residents said they desired guidance on subsequent management (e.g., frequency of follow-up visits). OB/GYN providers explained that implementing the combined model will require dedicated resources for follow-up tracking. If patients will be followed in the OB/GYN clinic for ongoing PrEP care, they suggested establishing a system to monitor patients’ follow up care and onboard new residents to a patient’s status on PrEP. OB/GYN providers also recommended creating a specific role for a “PrEP Champion,” such as the ambulatory chief resident, to monitor prescription refills and follow-up. They also suggested patient-centric strategies, such as scheduling the PrEP clinic appointment before the patient leaves the OB/GYN clinic, providing appointment reminders, and even offering transportation assistance or telehealth follow-ups as options.
PrEP providers stated that the combined care model could be integrated into their existing health care processes. They explained that they already work in close proximity to the OB/GYN resident clinics, which would allow for streamlined referrals after patients’ GYN visits. They also described that OB/GYN clinics could offer direct referrals to a specific PrEP provider or clinic contact, helping clients feel more comfortable returning for follow-up care. PrEP providers also noted that OB/GYN residents would benefit from training on the advantages and trade-offs of referring patients for follow-up care either within their residency clinics or at specialized PrEP clinics. Lastly, they also expressed their own comfort in providing ongoing follow-up care for patients who initiated PrEP in a different clinical setting.
Process: Training
OB/GYN providers expressed that busy residency schedules mean the training must be efficient and possibly recurring. They liked the idea of an initial intensive training, such as a dedicated workshop in the orientation/lecture series, plus ongoing refreshers. Embedding PrEP topics into existing educational forums, such as weekly lecture series, or case conferences, was described as feasible and sustainable. Additionally, they said quick updates could be provided as new developments occur, for instance, if new PrEP guidelines are released, or if residents encounter a complex case, it could be debriefed in a meeting.
Working Group Meetings
We conducted two working group meetings in September 2022 and January 2023.
Working Group Meeting #1
A summary of the qualitative research findings was presented as a slide-show presentation at the initial working group session with OB/GYN leadership, faculty, and residents to gather insights for integrating HIV prevention into women’s health settings. Working group providers gave a detailed overview of the OB/GYN residency program, including that residents practice across a variety of clinical settings standard to any residency program. After considering the qualitative research findings within their broader context, they offered the following recommendations:
Educational Materials
They suggested the creation of a manual, in the form of a binder to be maintained in the physician workroom, that would contain key information on how to counsel patients and technical details on how to prescribe PrEP. They also suggested an educational video covering PrEP basics be produced to use during the training and to reference easily if needed following the training.
Resident Training Program
Leadership determined than an initial 3-hour training with role play could be held during a normal weekly didactic period, ideally to be repeated on an annual basis as new residents enter the residency. Program leadership also felt that it would be important to invite faculty to the training. They suggested that a briefer form of the training should be repeated at the beginning of each clinic block (i.e., monthly).
PrEP Champions
Residents and Leadership agreed that it would be important to have a resident to champion the intervention. Leadership felt that there would be value in having a faculty member serve as a champion as well.
Protocols
OB/GYN Residents re-emphasized the need for protocols to be in place to provide guidance on who would call the patient back about their labs. They also suggested a “beta book” (similar to what was used to track β-hCG while monitoring pregnancy for potential failure) be used to track patients.
Telemedicine
OB/GYN Residents and leadership noted that clinics are often booked out months in advance, making follow-up scheduling difficult. They liked the idea of telemedicine to facilitate the scheduling of follow-up visits.
Working Group Meeting #2
After the research team created the draft resident training program based on the qualitative findings and feedback from the first OB/GYN provider working group, a second provider workgroup was held to review and solicit feedback on the components of the training program, and to discuss additional suggestions on intervention implementation. The group expressed their enthusiasm about the training and felt the components were very consistent with the input they had provided during the interviews and initial working group session. Minor additional suggestions including developing an EHR note template that the residents could add as a “smartphrase” at the beginning of each clinic block, and the addition of a “one-pager” summary to include counseling guidance and the technical aspects of PrEP prescribing, that should be laminated with several copies placed in the provider workroom for easy reference during clinics (see supplement for the final training program).
Discussion
In this manuscript, we describe the development process for the OB/GYN component of the “Start the Conversation” initiative, starting with in-depth interviews to explore factors influencing implementation of PrEP prescribing and follow-up care by OB/GYN residents. Our findings highlight a complex interplay of outer setting factors (e.g., patient needs, stigma, health system barriers), inner setting characteristics (e.g., clinic workflow, resources, organizational culture), provider-level attributes (e.g., knowledge, attitudes, self-efficacy), and intervention design components that collectively will determine the success of integrating PrEP into routine gynecologic care.
Our qualitative findings underscore that OB/GYN resident clinics can be appropriate and feasible settings for HIV prevention among cisgender women, but realizing this potential requires addressing several challenges. Providers suggested that Black women patients in their clinic often lack awareness of their HIV risk and of PrEP as a prevention option, echoing broader public health data on low PrEP uptake in this group. 27 These findings are consistent with a growing body of qualitative literature documenting low PrEP awareness and misperceptions among both women and their OB/GYN providers across diverse settings. For example, Khospropour et al found similar patterns among OB/GYN practice staff in upstate New York, where providers reported that they “honestly didn’t know it was for women too,” 28 and Pratt et al documented analogous misconceptions among gynecology providers and patients. 29 These converging findings across geographic settings suggest that PrEP awareness gaps are not unique to our program but likely rather a systemic challenge in women’s health care nationally. Encouragingly, our OB/GYN providers viewed HIV prevention services as part of their professional role, aligning with ACOG’s call for obstetrician-gynecologists to discuss PrEP with all at-risk patients. 14
Not unexpectedly, our development process revealed that integrating PrEP into clinical practice involves more than issuing a guideline: it demands changes in clinic processes and provider behavior. Time and workflow constraints emerged as a major barrier. High-volume OB/GYN practices often allocate limited time per patient, and adding PrEP counseling could strain these encounters. These time pressures are not unique to our setting; Young et al reported that even one year after implementing a PrEP curriculum in an OB/GYN residency program in Chicago, workflow integration and follow-up remained persistent challenges, with residents identifying systemic barriers such as overbooking and lack of a standardized PrEP follow-up protocol. 22 The consistency of these barriers across residency programs underscores the need for implementation strategies that go beyond training curricula to address structural clinic-level constraints. This approach is further supported by Johnson et al, who used the CFIR-ERIC matching tool to map implementation strategies to PrEP barriers for women at a Chicago-based health center, identifying EMR optimization and clinical champions as strategies specifically matched to inner-setting barriers like workflow integration and time constraints. 30
Another key finding is the importance of trust and patient-provider relationships in facilitating PrEP uptake. Providers said that fear of judgment is a likely deterrent for patients, but trusting relationships with OB/GYN residents could potentially mitigate that barrier. Thus, OB/GYN practitioners have a unique advantage – their established rapport with patients which they can harness to introduce PrEP in a non-stigmatizing way. 13 However, our findings also pointed to the potential downside of discontinuity—that is, rotating resident schedules make it harder to build trust. This tension between a trust advantage of OB/GYN settings and the discontinuity inherent in residency training programs has not been extensively discussed in the existing PrEP literature, which has largely focused on continuity-based primary care or dedicated PrEP clinic settings. Our findings highlight a distinctive implementation challenge for residency-based PrEP programs and suggest that strategies to maintain relational continuity, such as designating a PrEP champion or using a shared patient tracking system, may be essential to preserving the “trust advantage” that OB/GYN settings otherwise can offer. The PrEP champion strategy aligns with emerging evidence that clinical champions can serve as a key implementation strategy for improving PrEP uptake, as recommended by the CFIR-ERIC matching framework. 30
Another message from this study is the crucial role of provider education – specifically, training OB/GYN residents in improving PrEP delivery. OB/GYN residents and program leadership voiced enthusiasm for training and outlined specifically where training was needed—not just for the medical aspects of care, but also for achieving realistic program implementation, such that they gain an understanding of practical aspects of PrEP provision (e.g. insurance coverage, and patient tracking, follow up monitoring, and referral). This emphasis on “practical” over purely “clinical” knowledge distinguishes our findings from earlier PrEP training evaluations that focused primarily on pharmacological knowledge and prescribing confidence. While national resources such as those provided by the AIDS Education and Training Centers (AETCs) and Prevention Training Centers (PTCs) address PrEP clinical knowledge broadly, they are often not tailored to the specific workflow, scheduling, and supervisory structure of OB/GYN residency programs. Our participatory design process produced a training model that addresses these site-specific operational realities, including the need for recurring refresher sessions aligned with resident rotation schedules, EHR-integrated prescribing tools, and laminated quick-reference materials designed for high-volume clinic environments. Additionally, if programs are to incorporate long-acting PrEP, they will need to educate on both the unique medical and implementation aspects of long-acting formulations. Given the anticipated pipeline of long-acting regimens in the coming years, training programs must maintain flexibility to accommodate new medications and their indications, as well as the nuances of the real-world prescribing of these medications in practice.
Our intervention’s combined-care model, wherein OB/GYN providers initiate PrEP and then link patients to follow-up care, emerged as both promising and challenging in our analysis. Our findings suggest that this model could improve PrEP access for women by leveraging the OB/GYN visit as a critical entry point. The combined-care approach addresses this by ensuring women start PrEP in a familiar clinical setting, their OB/GYN clinic, without the need for multiple preliminary steps. Then if patients opt for PrEP clinic follow-up, they have access to specialist expertise for maintenance, which could potentially improve quality of care. PrEP clinic providers are typically well-versed in managing PrEP follow-up (i.e., monitoring labs, adherence counseling, managing side effects). Our PrEP providers were confident in taking on referred patients and providing the intensive follow-up that resource-strapped OB/GYN clinics might struggle to provide. Yet, outside referral has inherent limitations, including the risk of fragmentation and patient drop-off during the transition from OB/GYN to PrEP clinic. This concern is supported by emerging evidence that care transitions remain a critical vulnerability in PrEP persistence among women. 27 Our model’s emphasis on shared decision-making—allowing patients to choose between OB/GYN-based and PrEP clinic-based follow-up—represents an important patient-centered dimension that most existing models do not incorporate. It also resonates with recent calls to center Black women’s autonomy and preferences in PrEP service delivery, recognizing that a one-size-fits-all referral pathway may not serve the needs of this population.4,5
Notably, PrEP provision differs from many other clinical innovations in OB/GYN settings because it requires not only prescribing knowledge but also sustained counseling about HIV risk, navigation of stigma, and ongoing follow-up monitoring, tasks that extend beyond the typical scope of a single OB/GYN visit. Unlike the introduction of a new contraceptive method or screening protocol, where management can be integrated into routine visit structures, PrEP demands a parallel system for monitoring adherence, laboratory values, and care continuity, akin to the infrastructure required for managing chronic conditions. Participants in our study recognized this distinction and proposed practical solutions drawn from existing workflows. For example, they recommended adapting the “beta book”, a tracking system used to monitor β-hCG levels for patients experiencing spontaneous abortion, as a model for PrEP patient tracking. This creative adaptation of a familiar clinical tool exemplifies how providers can leverage existing workflows to manage new responsibilities, much as they already ensure follow-up for conditions such as STI co-infections or gestational diabetes.
Ultimately, based on our working group conversations, we designated an OB/GYN resident as a PrEP champion to help address insufficient time concerns and clinic workflow constraints, designed a training program that included an initial 3-hour training and brief refresher trainings monthly, and planned for educational materials and protocols to be in place with program initiation.
Limitations and Strengths
This study has several limitations. First, the sample of OB/GYN providers was drawn from a single residency program in New Orleans, Louisiana, which may limit transferability to other settings. However, the qualitative descriptive design was intentionally focused on informing a site-specific intervention, and many of the themes identified—such as time constraints, knowledge gaps, and the need for workflow integration—are consistent with the broader literature on PrEP implementation in OB/GYN settings across geographically diverse programs.22,28,30 Additionally, the provider workgroup was intentionally composed of OB/GYN residents and leadership from three local residency programs to seek out generalizable feedback. Second, the sample size of 12 participants across three stakeholder groups may be perceived as modest; however, our sampling approach was guided by information power rather than saturation, which is appropriate for applied qualitative research aimed at intervention development. Third, this study focused on provider perspectives and did not include patient perspectives on PrEP delivery in OB/GYN settings, which is an important direction for future research. Our team’s prior research with Black women, along with feedback from our community partners, directly informed the decision to develop an OB/GYN-focused component. 4 Strengths of this study include the systematic use of the CFIR framework to guide both data collection and analysis, the inclusion of multiple stakeholder perspectives (residents, faculty/leadership, and PrEP providers), and the iterative design process that incorporated qualitative findings into provider working group discussions to design the intervention. The participatory approach ensured that the resulting training program reflected the practical realities of the OB/GYN clinical environment. An additional strength is the grounding of the work in a community with a high burden of HIV among Black women, which enhances the relevance of the resulting intervention for the population most affected. Taken together, these strengths and the limitations noted above should be weighed when interpreting and applying these findings.
Conclusion
OB/GYN clinics represent a feasible and appropriate setting to integrate PrEP into women’s preventive healthcare, reaching a popsulation that has been underserved in HIV prevention. Our CFIR-guided qualitative study and provider-informed design process produced a training model with a combined-care follow-up approach with a PrEP champion designation. Despite challenges related to time, workflow, and care continuity, providers expressed strong enthusiasm for PrEP integration. These findings informed a subsequent pilot trial, the results of which will be reported separately.
Supplemental Material
Supplemental Material for Start the Conversation: Development of a Training Program to Build OB/GYN Resident Capacity for PrEP Prescribing in Routine Care by Whitney C. Irie, Amy Corneli, Brian Perry, Clare Kelsey, Jacquelyn Bickham, Tamachia Davenport, Amber Naresh, Stacey Holman and Meredith Clement in Journal of the International Association of Providers of AIDS Care (JIAPAC).
Acknowledgements
We are grateful to the individuals who participated in the qualitative interviews and to the provider working group for sharing their insights on integrating PrEP into OB/GYN residency programs.
Author Contributions: AC and MEC conceptualized and designed the overall study. WCI, AC, and MEC conceptualized the paper. WCI wrote the original draft of the manuscript. AC and MEC contributed to subsequent manuscript drafts, providing critical revisions to intellectual content and methodological framing. BP conducted the qualitative interviews and data analysis. CK, JB, TD, AN, and SH contributed to study conception and design, with specific attention to incorporating community and residency program perspectives. All authors read and approved the final version of the manuscript.
Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The National Institute of Mental Health selected this project for a three-year grant starting in 2022 (R34MH129211). NIH had no role in the study design, data collection, data analysis, decision to publish, or manuscript preparation. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material: Supplemental material for this article is available online.
ORCID iDs
Whitney C. Irie https://orcid.org/0000-0002-8228-7206
Meredith Clement https://orcid.org/0000-0002-0283-6368
Ethical Considerations
The two IRBs associated with this study determined it qualified for exempt research status and informed consent was waived. We provided an informational sheet describing the purpose of the interviews and related information (e.g., risks) to all participants during the recruitment process.[ The two Institutional Review Boards associated with this study (protocol numbers Pro00113159 and 2163) determined it qualified for exempt research status under 45 CFR 46.104(d)(2). Per U.S. Federal Regulations, research determined exempt under 45 CFR 46.104 is also exempt from informed consent under 46.116 and documentation of consent under 46.117. We were therefore not required to obtain informed consent (written or oral).]
Consent for Publication
Not applicable. No individual-level identifiable data are included in this manuscript.
Data Availability Statement
The qualitative datasets generated and analyzed during the current study are not publicly available due to the sensitive nature of the interview data and the potential risk of participant identification, but de-identified excerpts may be made available from the corresponding author upon reasonable request and with appropriate ethical approvals.*
References
- 1.Mann LM, Zhu W, Huang YLA, Kourtis AP, Fanfair RN, Hoover KW. Trends in Oral and Injectable HIV Preexposure Prophylaxis Prescriptions in the US, 2013-2023. JAMA. 2024;332(18):1580-1583. doi: 10.1001/jama.2024.21493. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Irie WC, Calabrese SK, Patel RR, Mayer KH, Geng EH, Marcus JL. Preferences for HIV Preexposure Prophylaxis Products Among Black Women in the U.S. AIDS Behav. 2022;26(7):2212-2223. doi: 10.1007/s10461-021-03571-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Boudreaux J, Valdebenito CM, Pichon LC. Identifying Access Barriers to PrEP Among Cisgender Black/African American Women in the United States: A Systematic Review of the Literature. Healthcare. 2025;13(1):86. doi: 10.3390/healthcare13010086. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Clement ME, Perry B, McKenna K, et al. Identifying Implementation Strategies to Enhance HIV Pre-Exposure Prophylaxis Uptake Among Black Cisgender Women in New Orleans, Louisiana. AIDS Patient Care STDs. 2024;38(3):144-150. doi: 10.1089/apc.2023.0300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Irie WC, Terry M, Apata O, et al. “Educating, demystifying, destigmatising”: Black women’s perspectives on effective PrEP messaging in the USA. Cult Health Sex; 2025:1-12. 10.1080/13691058.2025.2538213. Published online. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Hirschhorn LR, Brown RN, Friedman EE, et al. Black Cisgender Women’s PrEP Knowledge, Attitudes, Preferences, and Experience in Chicago. J Acquir Immune Defic Syndr 1999. 2020;84(5):497-507. doi: 10.1097/QAI.0000000000002377. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Bunda BA, Raniele RA, Lapayowker SA, et al. Self-Perception of HIV Risk and Interest in Pre-Exposure Prophylaxis in a General Obstetrics and Gynecology Clinic Population. J Womens Health 2002. 2023;32(12):1380-1387. doi: 10.1089/jwh.2023.0153. [DOI] [PubMed] [Google Scholar]
- 8.Nydegger LA, Dickson-Gomez J, Ko Ko T. A Longitudinal, Qualitative Exploration of Perceived HIV Risk, Healthcare Experiences, and Social Support as Facilitators and Barriers to PrEP Adoption Among Black Women. AIDS Behav. 2021;25(2):582-591. doi: 10.1007/s10461-020-03015-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Tekeste M, Hull S, Dovidio JF, et al. Differences in Medical Mistrust Between Black and White Women: Implications for Patient-Provider Communication About PrEP. AIDS Behav. 2019;23(7):1737-1748. doi: 10.1007/s10461-018-2283-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Irie WC, Mahone A, Johnson B, et al. “Just the Stigma Associated with PrEP Makes You Feel Like It’s HIV Itself”: Exploring PrEP Stigma, Skepticism, and Medical Mistrust Among Black Cisgender Women in Urban and Rural Counties in the U.S. Deep South. Arch Sex Behav. 2024;53(3):1187-1195. doi: 10.1007/s10508-023-02769-2. [DOI] [PubMed] [Google Scholar]
- 11.Mazzoni S, Brewer S, Durfee J, et al. Patient Perspectives of Obstetrician-Gynecologists as Primary Care Providers. J Reprod Med. 2017;62(1-2):3-8. [PubMed] [Google Scholar]
- 12.Danvers AA, Chew Murphy E, Avila K, et al. Women Trust Their OBGYNs to Provide Preexposure Prophylaxis: An Opportunity for HIV Prevention. Front Reprod Health. 2022;4:832287. doi: 10.3389/frph.2022.832287. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Butler SK, Kislovskiy Y, Bunge K, Wiesenfeld HC. Implementing pre-exposure prophylaxis for HIV prevention in women: the role of the obstetrician-gynecologist. Am J Obstet Gynecol. 2022;226(6):764-772. doi: 10.1016/j.ajog.2021.12.263. [DOI] [PubMed] [Google Scholar]
- 14.ACOG Committee Opinion no 595 . Committee on Gynecologic Practice: Preexposure prophylaxis for the prevention of human immunodeficiency virus. Obstet Gynecol. 2014;123(5):1133-1136. doi: 10.1097/01.AOG.0000446855.78026.21. [DOI] [PubMed] [Google Scholar]
- 15.Preexposure prophylaxis for the prevention of HIV infection in the United States -- 2021 update: a clinical practice guideline. 2021. Accessed November 24, 2025.https://stacks.cdc.gov
- 16.Mullis CE, McWalters J, Avila K, Finkenberg C, Keller MJ, Golub SA. Identification of Provider Barriers and Facilitators to Integration of Pre-Exposure Prophylaxis into Postpartum Care. AIDS Patient Care STDs. 2026;40(3):100-108. doi: 10.1177/10872914261416608. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Ralph JA, Westberg SM, Boraas CM, Terrell CA, Fischer JR. PrEP-aring the general gynecologist to offer HIV pre-exposure prophylaxis. Clin Obstet Gynecol. 2022;65(4):733-738. doi: 10.1097/GRF.0000000000000713. [DOI] [PubMed] [Google Scholar]
- 18.Silvestri F, Alvarez N, Afzal O, Urbina AE, Dolan SM, Ramirez Zamudio A. Training obstetrician gynaecologists in HIV PrEP (pre-exposure prophylaxis): a 2-year experience. Sex Transm Infect. 2023;99(5):348-350. doi: 10.1136/sextrans-2022-055691. [DOI] [PubMed] [Google Scholar]
- 19.Wang R, Fruhauf TF, Sao SS, Gingher EL, Martin SJ, Coleman JS. Clinic-based interventions to increase preexposure prophylaxis awareness and uptake among United States patients attending an obstetrics and gynecology clinic in Baltimore, Maryland. Am J Obstet Gynecol. 2023;229(4):423.e1-423.e8. doi: 10.1016/j.ajog.2023.07.046. [DOI] [PubMed] [Google Scholar]
- 20.Ramirez A, Urbina A, Afzal O. A missing key in ending the AIDS epidemic: training Ob/Gyn resident physicians in the management of HIV PrEP. Am J Obstet Gynecol. 2019;221(6):688. Abstract 33. [Google Scholar]
- 21.Berhie SH, Tsai S, Gerber S, Yee LM. Didactic and Simulation to Improve Obstetrics and Gynecology Trainee Expertise in HIV pre-exposure prophylaxis (PrEP). Am J Obstet Gynecol. 2022;226(1):S555. Abstract 870. [Google Scholar]
- 22.Young AMP, Berhie S, Pedamallu H, Patterson L, Yee LM. Assessing Barriers in Obstetrics and Gynecology Trainee Knowledge and Prescribing of HIV Pre-Exposure Prophylaxis in a High-Risk Community. Womens Health Rep. 2024;5(1):825-830. doi: 10.1089/whr.2024.0123. [DOI] [Google Scholar]
- 23.Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334-340. doi: 10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
- 24.Averill JB. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qualitative Health Research. 2002;12(6):855-866. [DOI] [PubMed] [Google Scholar]
- 25.Guest G, MacQueen KM, Namey EE. Applied Thematic Analysis. Sage; 2012. [Google Scholar]
- 26.Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357. doi: 10.1093/intqhc/mzm042. [DOI] [PubMed] [Google Scholar]
- 27.Deeper Look: PrEP - AIDSVu. AccessedOctober 17, 2023.https://aidsvu.org/resources/deeper-look-prep/
- 28.Khosropour CM, Healy E, Murphy EM, et al. I honestly didn’t know it was for women too…” acceptability and feasibility of integrating PrEP services into OB/GYN practices from the perspectives of practice staff and cisgender women in the community: a qualitative study. Front Health Serv. 2025;5:1567688. doi: 10.3389/frhs.2025.1567688. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Pratt MC, Goymer H, Burgan K, et al. Qualitative analysis of patient and key informant interviews to inform integration of HIV pre-exposure prophylaxis services into gynecology care in Alabama. Womens Health. 2025;21:17455057251331714. doi: 10.1177/17455057251331714. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Johnson AK, Devlin SA, Pyra M, et al. Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis. JMIR Form Res. 2024;8:e59800. doi: 10.2196/59800. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplemental Material for Start the Conversation: Development of a Training Program to Build OB/GYN Resident Capacity for PrEP Prescribing in Routine Care by Whitney C. Irie, Amy Corneli, Brian Perry, Clare Kelsey, Jacquelyn Bickham, Tamachia Davenport, Amber Naresh, Stacey Holman and Meredith Clement in Journal of the International Association of Providers of AIDS Care (JIAPAC).
Data Availability Statement
The qualitative datasets generated and analyzed during the current study are not publicly available due to the sensitive nature of the interview data and the potential risk of participant identification, but de-identified excerpts may be made available from the corresponding author upon reasonable request and with appropriate ethical approvals.*