The proportion of learners who reported being “very knowledgeable” about evidence-based guidelines for HIV prevention, including the use of PrEP in individuals at risk for infection, increased from 25% at baseline to nearly 68% at the conclusion of the activity. Similarly, the percentage who felt “not at all” knowledgeable about HIV prevention guidelines decreased from 28% pre-activity to 2% post-activity (Figure 3).
Figure 3. Knowledge assessment question results.
The majority of participants in all activities reported that they had gained confidence in their ability to identify patients who are appropriate candidates for HIV prevention strategies, utilize HIV prevention interventions in patients at risk, and employ culturally competent education and HIV prevention counseling strategies.
At baseline, just over half of learners said they provided PrEP or referred patients to sources where they could obtain it; after participating in an IMPACT activity, nearly 90% said they would prescribe PrEP or refer for it. The proportion who said they would not do either dropped from approximately one-fourth of the participants to less than 3%. Notably, the number of learners who said that prescribing PrEP is not relevant to their practice dropped from nearly 20% to less than 8% (Figure 4).
Figure 4. Competence question results.
Changes Made in Practice
Learners were asked 8 weeks after the activity whether they had made changes in their practice following their participation in the IMPACT program.
- The percentage who said they always or often identify patients who are appropriate candidates for HIV prevention strategies doubled, from 33% prior to the activity to 66% at the time of the outcomes survey.
- The percentage who said they make use of HIV prevention strategies in patients at risk nearly doubled, from 37% preactivity to 70% later.
- The percentage who said they employ culturally competent education and HIV prevention counseling strategies for individuals at risk rose from 37% preactivity to 68% (Figure 5).
Figure 5. Reported changes in practice following participation in the IMPACT program.
To determine the patient-level impact of the activity, learners were asked via a postevaluation survey how many patients on average they see each day; how many days per week, on average, they see patients; and what percentage of the patients they treat are at risk for HIV infection. Analysis of these data indicates that the education has the potential to have an impact of 22 patients at risk for HIV infection per participant, per week (Figure 6).
Figure 6. Patient-level impact of the activity.
When asked at the 8-week follow-up survey to define the positive results that the education had on patient outcomes, participant responses included:
- Can take good sexual history and identify patients at risk
- Exceptional counseling and education to patients at risk for HIV
- Excellent improvements in identifying patients who are appropriate candidates for HIV prevention strategies
- Higher utilization of PrEP
- I feel more confident talking to patients and helping them feel more comfortable taking about issues related to HIV and sexual health
- Patients are more receptive; I am confident counseling patients on the subject
Findings from specific CME/CE activities included the following:
- A monograph educating participants was distributed in conjunction with the curriculum. The percentage of learners who knew that MSM bear the heaviest burden of HIV infection increased from 71% prior to the release of the monograph to 93% following the release. Additionally, the proportion who knew that adherence to PrEP among young MSM dropped off fastest among young black MSM increased from 65% to 95%.
- After the satellite symposium at SYNChronicity, the proportion of learners who could state the correct level of risk reduction associated with 5 daily doses of PrEP increased from 44% to 93%. The percentage who said they would provide PrEP to appropriate patients, or refer patients to resources where they might be able to obtain it, increased from 65% to 83%. At the beginning of the activity, 48% reported they would educate patients about appropriate HIV prevention strategies; at the end, 64% said they would do so.
- Following the satellite symposium at the annual meeting of the National Hispanic Medical Association, the percentage of participants who knew that follow-up visits for patients taking PrEP, based on CDC recommendations, should occur every 3 months increased from 57% to 97%.
- Learners also demonstrated improvement in their understanding that patients’ needs for safer sexual practices and for intimacy with their partners were the principal reasons for adherence to the PrEP regimen (25.7% pre-test vs 88.6% post-test).