Only 14% of US Family Medicine Programs Report Substantial PrEP Training

Residency training in pre-exposure prophylaxis (PrEP) lags in small, rural communities, results of a survey show.

To investigate residency training, competency, and HIV PrEP prescribing according to population size, researchers throughout the United States surveyed 522 family medicine program directors as part of the Council of Academic Family Medicine Educational Research Alliance survey from January 2018 through February 2018. The survey completion rate was 53% (276 of a total 522).

Of these respondents, 16% reported no PrEP residency training and no clinical provision of PrEP for patients. Another 11% of program directors reported clinical PrEP prescribing for patients despite no PrEP residency training. About half of the program directors (52%) reported that some PrEP residency training was included in their programs, and 14% reported substantial PrEP training in their programs.

Survey results by population size served by a residency training program indicated that no programs in rural communities with a population of less than 30,000 offered substantial PrEP training to their residents, although those in rural communities with a population of at least 30,000 offered this level of training more frequently (in 17% of programs, or 41 of 246 programs; P = .02).

However, a highly significant association was found between programs with substantial PrEP training and PrEP prescribing for most of the PrEP-appropriate patients in the practice (odd ratio [OR], 7.3; P < .001) or independent or advanced PrEP competency among graduating residents (OR, 18.3; P < .001).

The greatest barriers to PrEP prescribing were lack of faculty expertise (in 23% of programs), an insufficient number of high-risk patients (21%), inadequate screening (15%), and poor resident knowledge (12%).

“Barriers identified in this study can help inform curricular needs to improve primary care workforce capacity to lower HIV risk,” the researchers concluded.


—Ellen Kurek



Jasper BK, Becker JN, Myers AE, Cronholm PF. HIV preexposure prophylaxis training in family medicine residencies: a national survey. Fam Med. 2022;54(1):24-29. doi:10.22454/FamMed.2022.740210