Table 3 Exemplar quotes by theme

Theme 1: Optimizing CDS integration within the primary care workflow (CFIR domain: Intervention)

“I think having something come up for HIV testing if their chlamydia is positive isn’t as helpful because by then the patient’s out of the office, so I think if we’re going to be ordering it, it makes more sense to order it at the time of the visit regardless of what the results of the [STI test] are.”—General pediatrician, cisgender female

“…I think, you’d find all the people onboard. I think, as I said, just please pilot things. Because we always start getting told that things are getting piloted, but sometimes they just get introduced. And then, having like…someone who doesn’t do this all the time onboard to kind of give feedback…”—General pediatrician, cisgender female

“It comes from feeling like all we do is click now. It comes from feeling like we can’t – we’re not talking to our patients, we’re clicking boxes….”—General pediatrician, cisgender female

Theme 2: Designing for standardization, with room for adaptable CDS design (Intervention)

“I would strongly suggest in areas where chlamydia prevalence is greater than 20 percent that we engage in universal screening, for at least GC and chlamydia, and then maybe starting HIV at 15, doing it with rapid HIV, removing stigma, having everyone screened before they even see their provider, to remove bias.”—General pediatrician, cisgender female

“If it’s a negative screen it’ll say negative screen. If it’s a positive, then it’ll give you suggestions and links on things that you can do. And if it’s emergent it’ll also save that for you. So, you want the tool to kind of not just ask the questions but help guide you through what to do with the answers.”—Adolescent Medicine physician, cisgender female

Theme 3; Inner Setting (III) Recognizing the need for confidential care (Outer Setting)

“…I feel like it’s possible that a female patient with private insurance might be more inclined to not want their parents to know – which would decrease testing.”—General pediatrician, cisgender female

Theme 4: Improving accurate HIV risk perception (Outer Setting, Individuals)

“I think females just don’t perceive that they’re as much at risk [of HIV infection]…adolescents just have a very skewed view of risk in general.”—General pediatrician, cisgender female

“I think education…about numbers of people that are HIV positive in proportion of males versus females would be helpful…maybe looking at the data and seeing who's being tested and seeing where we miss might help us realize that we should be testing more than we are – so doing some data analysis and looking at the percent of males versus females that I test personally may really hit at home for me that I'm falling short even though right now I feel like I test as many, but I might not be.”—General pediatrician, cisgender female

Theme 5: Recognizing limitations of time and staff as available resources (Inner Setting)

“I know one of our nurses at [clinic] has been thinking about sort of like a much more nurse-led visit. And I think that could be something that allows you to better use all of your team members and take advantage of the time that the families and the – like less wasted time with them sitting around and more time when people are really working with them to address issues and prioritize.”—General pediatrician, cisgender female

Theme 6: Prioritizing HIV relative to other primary care needs (Inner Setting)

“I think, again, importance in priorities, and a lot of things are happening at that [visit], and you’re dealing with depression and school issues, and so [providers] have to pick and choose.”—Adolescent Medicine boarded pediatrician, cisgender female

“I don't think people here deliberately ignore PrEP. I think in the grand scheme of everything that you have to deal with, with a teenager and you’re given 15, maybe 30 min at best… If you want to talk about every single thing that you could possibly talk about that this kid needs, you're well over an hour visit.”—Nurse practitioner, female

Theme 7: Increasing provider knowledge about HIV testing and PrEP (Individuals)

“So, I have never prescribed PrEP, so I wouldn't feel 100 percent comfortable prescribing it. But I would feel comfortable saying that she should consider that and recommend it.”—General pediatrician, cisgender female