HIV Preexposure Prophylaxis Among Adolescents in the US

Abstract

IMPORTANCE Many adolescents and young adults in the US are disproportionately affected by HIV. Several others who are uninfected are at risk and in need of effective preventive strategies. The uptake rate of preexposure prophylaxis (PrEP) for HIV prevention has remained low among US adolescents. This review assesses the current status of PrEP uptake among at-risk adolescents aged 13 to 19 years and recommendations for improving PrEP access, uptake, and future needed directions, including specific recommendations for health care professionals.OBSERVATIONS Of the 37 377 new HIV diagnoses made in 2018, 7734 diagnoses (21%) occurred in adolescents and young adults aged 12 to 24 years; of these, 1707 diagnoses (22%) occurred in adolescents aged 13 to 19 years. The greatest burden of HIV is found among young African American men who have sex with men, accounting for two-thirds of all HIV infections in adolescents and young adults. Preexposure prophylaxis awareness and engagement are lowest in adolescents with the greatest risk for HIV. Adolescent primary care clinicians and specialists do not routinely offer HIV testing as recommended by the Centers for Disease Control and Prevention or routinely assess sexual risk exposures of patients through sexual history taking. Clinicians' decision to prescribe PrEP for adolescents is often guided by their perceptions of the patient's HIV risk and their knowledge and acceptance of PrEP guidelines. State laws on consent, confidentiality, and the rights of the adolescent to independently access PrEP outside of parental influence differ across jurisdictions, often limiting access and uptake.CONCLUSIONS AND RELEVANCE Use of PrEP in adolescents at risk for HIV is an important component of HIV prevention. Optimizing uptake includes improving clinicians' knowledge about HIV risk and prevention strategies, enhancing sexual history taking and risk assessment through training and retraining, and improving PrEP knowledge and acceptance of prescribing among clinicians. Leveraging the ubiquity of social media, encouraging family support, and performing research aimed at finding lifestyle-congruent formulations can help mitigate HIV transmission in adolescents at greatest risk for HIV.

“These Girls Have a Chance to be the Future Generation of HIV Negative”: Experiences of Implementing a PrEP Programme for Adolescent Girls and Young Women in South Africa

“…Family tensions and conflict arose when parents discovered their adolescent was taking PrEP without their knowledge, creating challenges even when legally, consent from parents is not required. This point is discussed in the literature on the ethical and legal issues of requiring parental/guardian consent for PrEP amongst adolescents, which can inhibit access and uptake for the reason that requesting consent entails disclosure of sexual activity [ 25 , 26 ]. Debates on parental consent for PrEP centre around interpretation of the South African Children’s Act 38 of 2005, which makes provision for children from the age of 12 to give their own consent for medical treatment; in this case, if PrEP is interpreted as ‘medical treatment’, then self-consent for PrEP is permissible for persons over 12 years, if they have the mental capacity and maturity to understand the benefits, risks, social and other implications of the proposed treatment [ 5 , 20 , 27 ].…”

Public Health Detailing to Promote HIV Pre- and Postexposure Prophylaxis Among Women's Healthcare Providers in New York City

“…Adolescent health providers reported the lowest levels of PrEP prescribing, potentially owing to misinformation about patient indication or concerns for confidentiality, payment ability, or adherence. 33,34 Detailing may have addressed these barriers, with www.ajpmonline.org resources highlighting 2018 Food and Drug Administration approval updates for adults 35 and 2017 New York State public health law changes on guardian notification and consent for PrEP use by minors. 36,37 HIV/infectious disease providers reported high baseline PrEP prescribing to women patients, a finding consistent with preexisting provider familiarity around HIV prevention predating the campaign, 32 potentially related to the lack of change at follow-up.…”

Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents

“…In May 2018, HIV preexposure prophylaxis (PrEP) was approved for adolescents weighing at least 35 kg and recommended for any youth at risk of HIV infection due to substance use or other risks [57]. Yet, uptake among adolescents and young adults in the USA remains low [58][59][60]. Misinformation and mystery continue to surround HIV care and prevention in young adults.…”