Exploring adults as support persons for improved pre-exposure prophylaxis for HIV use among select adolescents and young adults in the Deep South

Abstract

Purpose Pre-exposure prophylaxis for HIV (PrEP) is an effective yet underutilized biomedical tool for adolescents and young adults’ (AYA) HIV prevention due to barriers such as PrEP adherence. We assessed HIV prevention knowledge, attitudes and beliefs from adults who self-identified as a primary support person to an AYA. Methods We surveyed AYA primary support persons at an academic hospital. Univariate and multivariate regression analyses were completed to identify factors associated with the belief AYAs engaging in HIV-associated behaviors should use PrEP and willingness to support AYAs on PrEP. Results 200 primary support persons completed the survey. Participants were predominately female (77%) and black (56%). Nearly all primary support persons believed AYAs engaging in HIV-associated behaviors should take PrEP (94%) and 98% would support an AYA taking PrEP via transportation to appointments, assistance with refilling prescriptions, medication reminders, or encouragement. Conclusions Primary support persons are willing to support AYAs using PrEP.

Implementing Pre-exposure Prophylactic Therapy in Primary Care

“…One significant barrier to PrEP use is an individual's awareness that PrEP is available. 11,15,16 An essential part of increasing the use of PrEP in primary care is the promotion of its availability in the clinic and individual assistance programs that cover the cost. Hanging PrEP posters in examination rooms and providing handouts can help spark interest and convey a safe space culture to have a conversation with the NP about PrEP.…”

“…4 Step 3: Assess Commitment and Support Daily medication adherence may be challenging, especially for individuals who do not have regular or stable housing or for those who travel frequently and may forget to take the medication with them wherever they go. 11 This should be discussed so the NP and individual can troubleshoot and devise a strategy for successful adherence. FTC/TDF and FTC/TAF are often part of regimens to treat active HIV infections, and lack of knowledge that the medication can also be taken to prevent HIV acquisition may result in stigma from others.…”

“…This is especially true for individuals living in the Deep South, likely due to strongly conservative religious and political views common in this geographic area. 11,15 Lack of individual support can also be a barrier. 11,15 This could include lack of support for the cost and payment for medication, transportation to appointments, and lack of support persons.…”

“…11,15 Lack of individual support can also be a barrier. 11,15 This could include lack of support for the cost and payment for medication, transportation to appointments, and lack of support persons. Support persons for Black adolescents were less likely to offer reminders to take medication and less likely to provide any financial support for PrEP.…”

“…4 The current CDC PrEP guidelines are limited to adults; however, the FDA approvals for FTC/TDF and FTC/TAF include adolescents who weigh at least 35 kg (77 pounds). 10,11 Adolescents, especially those who identify as LGBTQIA (lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual) can be at high risk of HIV acquisition; therefore, primary care NPs should consider these individuals as candidates for PrEP. Younger adolescents who have not reached maximum bone density before PrEP initiation may be at slight risk of reduced bone density, which can be mitigated by using FTC/TAF instead of FTC/TDF.…”