Wider Prescription of PrEP Requires Improved Guidelines, Coverage, and More

Published May 2019 | Journal of Adolescent Health

Improving HIV prevention care for adolescents requires more primary care providers (PCPs) who are willing to prescribe pre-exposure prophylaxis (PrEP) and equally willing to monitor patients who take it.

A study by the Division of Adolescent and Transition Medicine, based on face-to-face interviews with 38 PCPs who care for youth from ages 13 to 21, is helping pave the way, says Tanya Kowalczyk Mullins, MD, MS, the division’s director of research. “The physicians we surveyed identified a number of barriers that hadn’t been identified before, especially for adolescent patients.”

Likelihood of recommending PrEP to adolescents was highest among pediatricians, followed by adolescent medicine specialists, obstetrician/gynecologists and family medicine specialists. The PCP-identified barriers include lack of PrEP acceptability by the patient, low patient-perceived risk of HIV, lack of FDA approval of PrEP for teens (at the time of the study), and concerns about patient adherence, safety, side effects, and confidentiality.

PCP-identified benefits of PrEP included decreased HIV acquisition/rates, patients finding taking a pill for prevention to be acceptable, and improved adolescent reproductive health.

“Because adolescents at risk of HIV are most likely to receive medical care from PCPs, addressing PCP-perceived barriers to providing PrEP will be a critical step to improving access for adolescents,” Mullins explains. “There’s a lot more work we have to do to move PrEP into the primary care setting.”

Strategies to overcome physician barriers should include longitudinal safety and effectiveness research on PrEP, development of clinical guidelines, coverage, and clarifying confidentiality issues, Mullins says.

A follow-up national physician survey is underway.