Adolescent Human Immunodeficiency Virus Care Providers’ Attitudes Toward the Use of Oral Pre-Exposure Prophylaxis in Youth

Mullins, Tanya L. Kowalczyk; Zimet, Gregory D.; Lally, Michelle; Kahn, Jessica A.

doi:10.1089/apc.2016.0048

Cited by 40 publications

(37 citation statements)

References 36 publications

(49 reference statements)

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“…Another theme we identified in the literature was the belief that being on PrEP would cause individuals to engage in more ''risky'' behavior, such as having sex without a condom or not inquiring about STIs before engaging in sexual activity. 25,[27][28][29]33,34,36,37,39,42,43,45,49,50 Although in most studies worries about risk compensation were minimal, it did emerge as a common theme across the reviewed literature. Specifically, 26% of Washington State providers believed that being on PrEP could increase engagement in risky sexual behavior.…”

Section: Concerns About Behavioral and Health Consequencesmentioning

confidence: 99%

“…In nine reviewed studies, providers reported worries about adherence to the drug regimen and the strict follow-up requirements for daily PrEP usage. 27,28,31,32,[34][35][36]39,49 According to the CDC guidelines, patients on PrEP should follow up every 3 months to undergo HIV/STI testing, with tests for renal functioning twice yearly. 17 This level of care can present a burden to providers and their clinics, as they may not have the staff or time necessary to assess each patient.…”

Section: Interpersonal Stigmamentioning

confidence: 99%

“…36 Finally, providers in another study cited concerns about the large number of follow-up visits and how low adherence can lead to viral resistance. 39…”

Section: Interpersonal Stigmamentioning

confidence: 99%

See 2 more Smart Citations

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

Pleuhs

Quinn

Walsh

et al. 2020

AIDS Patient Care and STDs

138

128

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Increasing prescription of pre-exposure prophylaxis (PrEP) is imperative to ending the HIV epidemic in the United States. The objective of this review was to identify health care provider barriers to PrEP implementation. A systematic review was conducted in February 2019 using PubMed to identify barriers to PrEP prescribing practices in the United States. Targeted search terms surrounding PrEP and providers resulted in 222 original studies, 28 of which were ultimately included in our review, with data collected between 2011 and 2018. Six themes were identified across reviewed studies: (i) a lack of PrEP knowledge, (ii) the presence of the Purview Paradox, which refers to discordance in beliefs between HIV specialists and primary care providers on who should prescribe PrEP, (iii) concerns about PrEP costs, (iv) concerns about behavioral and health consequences, (v) interpersonal stigma, and (vi) concerns about patient adherence. A majority of providers were lacking knowledge regarding PrEP, resulting in discomfort in prescribing PrEP, or limited awareness and understanding of PrEP clinical guidelines. Discrepant opinions were identified regarding whether PrEP was best managed within primary care or specialty clinics. Other barriers included concerns about cost, patient adherence, and follow-up maintenance care. Finally, concerns about risk compensation and discomfort discussing sexual activities with patients who would benefit most from PrEP were apparent. Additional work is needed to prepare providers to prescribe and manage patients on PrEP, optimize PrEP delivery, and reduce provider bias. Future research is needed to identify providers' attitudes and beliefs regarding innovations in PrEP dosing, task shifting, and novel strategies for PrEP care.

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Section: Concerns About Behavioral and Health Consequencesmentioning

confidence: 99%

Section: Interpersonal Stigmamentioning

confidence: 99%

See 1 more Smart Citation

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

Pleuhs

Quinn

Walsh

et al. 2020

AIDS Patient Care and STDs

138

128

View full text Add to dashboard Cite

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“…Few studies have examined providers’ perspectives on PrEP specifically for adolescent and young adult patients. In some studies, clinicians have expressed concerns about potential challenges with adherence, adverse effects, high costs, and risk compensation for both adults and adolescents [31]. …”

Section: Other Considerations Regarding Prep For Youthmentioning

confidence: 99%

“…When asked to consider PrEP specifically for adolescent minors, U.S. providers described additional concerns including lack of clarity about confidentiality laws and ability to consent patients without parental involvement [31]. In a mixed-methods study in South Africa, 100% of clinicians in an HIV-treatment clinic said they would prescribe PrEP to adolescents who were sexually active [29].…”

Section: Other Considerations Regarding Prep For Youthmentioning

confidence: 99%

HIV preexposure prophylaxis for adolescents and young adults

Allen

Gordon

Krakower

et al. 2017

Current Opinion in Pediatrics

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STRUCTURED ABSTRACT Purpose of review This review describes the evidence for HIV pre-exposure prophylaxis (PrEP) with daily combined tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) in adolescents and young adults. Current recommendations are described, as are the unique medical, socioeconomic, and legal considerations regarding the use of PrEP for youth. Recent findings PrEP with daily oral TDF-FTC has been shown to help prevent new HIV infection among adults at substantial risk. Evidence suggests a protective benefit of PrEP for youth at risk for HIV, although low adherence is emerging as a barrier to effective use. Summary Effective use of antiretrovirals for PrEP represents a seminal development in HIV prevention efforts. Improving access and adherence to PrEP for youth has the potential to substantially reduce the incidence of HIV in this population.

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Policy considerations for scaling up access to HIV pre‐exposure prophylaxis for adolescent girls and young women: Examples from Kenya, South Africa, and Uganda

Lane

Brezak

Patel

et al. 2021

Health Planning & Management

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Adolescent girls and young women (aged 15-24 years; AGYW) continue to carry a disproportionate burden of HIV in sub-Saharan Africa. Pre-exposure prophylaxis (PrEP) helps reduce the risk of acquiring HIV for persons at substantial risk, including AGYW. As countries plan for the rollout of PrEP across sub-Saharan Africa, PrEP policies and programs could address the unique needs of AGYW.The purpose of this analysis was to identify policy considerations to improve AGYW access to PrEP. After reviewing the literature, we identified 13 policy considerations that policymakers and stakeholders could evaluate when developing or reviewing PrEP-related policies. We sorted these considerations into five categories, which together comprise an AGYW Access to PrEP Framework: AGYWfriendly delivery systems, clinical eligibility and adherence support, legal barriers and facilitators, affordability, and community and AGYW outreach. We also reviewed policies in three countries (Kenya, South Africa, and Uganda) to explore how PrEP-related policies addressed these considerations. Some of these policies addressed some of the 13 policy considerations, but none of the policies directly addressed the unique needs of AGYW for accessing PrEP.

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Adolescent Human Immunodeficiency Virus Care Providers’ Attitudes Toward the Use of Oral Pre-Exposure Prophylaxis in Youth

Abstract: Oral pre-exposure prophylaxis (PrEP) for human immunodeficiency virus

Cited by 40 publications

References 36 publications

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review

HIV preexposure prophylaxis for adolescents and young adults

Policy considerations for scaling up access to HIV pre‐exposure prophylaxis for adolescent girls and young women: Examples from Kenya, South Africa, and Uganda

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