Enhancing Pre-Exposure Prophylaxis Prescribing and Uptake Among Black Women in an Urban Sexually Transmitted Infections Clinic: A Quality Improvement Project

Abstract

Despite its known effectiveness, pre-exposure prophylaxis (PrEP) remains underutilized, particularly among Black women who experience disproportionately high rates of human immunodeficiency virus (HIV). This quality improvement (QI) project evaluated the impact of a provider education intervention, combined with a culturally tailored patient educational video, on PrEP prescribing, uptake, and documentation at an urban sexually transmitted infections (STI) clinic in Detroit, Michigan. Using a pre–post design, data were collected for 3 months before and after implementation of the intervention. Among 549 eligible Black women, PrEP prescribing increased from 3.6% pre-intervention to 11.4% post-intervention (p = 0.001). Among a small sample, nearly one-third of post-intervention patients who were prescribed PrEP received the medication within 30 days, compared with zero pre-intervention. This difference did not reach statistical significance (p = 0.08), likely due to limited sample size, but may be clinically meaningful. Documentation using the recommended International Classification of Diseases, 10th Revision (ICD-10) code Z29.81 for PrEP-related encounters improved from 21.5% to 88.3% (p < 0.001). Multivariable logistic regression analyses showed that post-intervention encounters were independently associated with higher odds of PrEP prescribing within 7 days of the clinical encounter and higher odds of the recommended ICD-10 code Z29.81 being utilized for PrEP-related services. Findings suggest that combining culturally responsive strategies with patient and provider education may improve PrEP prescribing, uptake, and documentation practices. The intervention was successful in addressing persistent disparities while offering a scalable model for similar clinical settings.