Date of Award

1-1-2018

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Julie Womack

Abstract

Background: On May 15, 2018, the Federal Drug Administration (FDA) approved once daily tenofovir/emtricitabine (TDF/FTC) for use as preexposure prophylaxis (PrEP) for adolescents (weighing greater than 35kgs) engaging in high-risk sexual behavior (Gilead, 2018). This decision was largely based on the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 113 which demonstrated that PrEP was well tolerated among the adolescents, age 15-17, enrolled in the study (Hosek, 2017). The use of TDF/FTC for PrEP in adults (18 and older) was approved by the FDA in 2012 after its safety and efficacy had been demonstrated in multiple international clinical trials (FDA, 2016).

Purpose: Adolescent providers are now in need of access to a comprehensive education curriculum on the administration of PrEP to adolescents. This paper outlines such a curriculum with the goals of reaching adolescent providers not familiar with the intricacies of PrEP assessment, administration and monitoring.

Methods: An extensive adolescent PrEP curriculum was designed using a comprehensive literature review. An expert panel of seven reviewed the curriculum for content validity. A pilot implementation of the curriculum was conducted with 54 staff members from eight school based health clinics located in Upper Manhattan and the Bronx. A Provider Manual was also designed, based on the content of the extended curriculum, for the purposes of having an easily accessible handbook for providers

Results: A comprehensive curriculum on the provision of HIV prevention modalities to adolescents has been successfully developed, piloted, and validated by a panel of experts. While the provision of PrEP can be as simple as writing a prescription, more is needed to engage and assess an adolescent in order to administer a multicomponent HIV prevention intervention. This curriculum contains content validated components that should be included when training clinicians how to administer PrEP to adolescents.

Conclusions: We have learned a great deal in the first 6 years of PrEP implementation in the United States, and this can be applied to the roll out of PrEP for adolescents. However, adolescents have a unique set of needs when it comes to a biomedical intervention for HIV prevention. The healthcare community, for the first time, has an intervention that can prevent the transmission of HIV among at-risk individuals if taken correctly. Given the high rates of HIV in the younger age groups, we have a considerable responsibility to determine how to efficiently and safely provide this intervention to youth. PrEP Implementation in a younger population requires a new set of youth focused guidelines, teaching points, and educational methodologies. Implications for Practice and Research: The validated curriculum developed through the stakeholder driven process may be an important contribution. Preventing HIV transmission in adolescents is a national and international priority and is undoubtedly an essential step necessary to end the HIV epidemic.

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