PrEPared to act: breaking barriers to HIV prevention in primary care for U.S. veterans, a quality improvement project

Abstract

Background: HIV (human immunodeficiency virus) remains a consequential public health threat, and untreated infection may progress to AIDS (acquired immunodeficiency syndrome) and life-threatening complications. Although PrEP reduces sexual HIV acquisition risk by about 99% when taken as prescribed, primary care delivery remains inconsistent because of knowledge gaps, stigma, and workflow barriers. Local Problem: A rural Veterans Affairs community-based outpatient clinic identified inconsistent HIV prevention practices during annual visits, including variable risk assessment, HIV testing offers, and patient PrEP education. Methods: A six-week quality improvement initiative was conducted from January 2 through February 13, 2026, using the Institute for Healthcare Improvement Model for Improvement and three Plan-Do-Study-Act cycles. Intervention: The intervention combined standardized provider education with a five- question assessment prompt used during annual visits to structure HIV risk discussion and document testing and education. Results: Across 206 attended annual visits, prompt utilization ranged from 85.7% to 100.0% and met the 85% goal in all six weeks. HIV testing improved from 55.8% to 81.8% and reached the 80% goal in Week 6. PrEP education improved from 5.8% to 77.3%, approaching but not reaching the 80% goal. Conclusion: A workflow-integrated assessment prompt was feasible in rural Veterans Affairs primary care and supported more consistent HIV prevention delivery. HIV testing offers and PrEP education improved over time, although additional workflow and documentation support appear necessary to strengthen follow-through.