Barriers to Adolescent Pre-exposure prophylaxis and Sexual Health Care in Pediatric Versus Family Medicine Providers

Abstract

Over 7000 youth ages 13–24 are diagnosed annually with HIV-1 in the United States despite the 2018 approval of oral pre-exposure prophylaxis (PrEP) for adolescents, highlighting the need for more research on provider prescribing practices in pediatric populations. Prior research chiefly focuses on patient barriers to accessing PrEP, and thus, our study explored provider barriers. From August to December of 2023, we conducted a survey of medical providers in pediatrics, family medicine (FM), and internal medicine (IM)/pediatrics. A 5-point Likert scale (0–4) assessed comfort in providing adolescent sexual health care and potential barriers to PrEP prescription, including discussions around sexual activity, gender identity, sexual orientation, sexually transmitted infections, and PrEP. In total, 158 responses were received. FM providers were more familiar with PrEP (3.4 to 1.5, 76.4% difference) and with prescribing PrEP (3.4–0.7, 131.2%) than pediatric providers. Logistic regression analysis found that FM providers were 32 times more likely to prescribe PrEP than pediatric providers. Pediatric providers were 3.4 times more likely than FM providers to identify barriers to PrEP prescription, notably “lack of time to counsel on risk reduction”, “lack of capacity for follow-up”, “lack of knowledge,” and “lack of comfort” and non-prescribers were 2.7 times more likely than prior prescribers to identify barriers, notably “lack of knowledge” and “lack of comfort”. This study highlights the crucial need for educational interventions for pediatric providers around PrEP provision, but also adolescent sexual health care more widely.