title: 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 (HIV) prevention is currently indicated for use in adults in the United States and may soon be indicated for minor adolescents. However, implementation of PrEP use among minors may present unique barriers. We conducted 15 individual, semi-structured interviews among US clinicians caring for HIV-infected and at-risk youth. The theory-driven interview guide assessed demographics, perceived role of oral PrEP in HIV prevention among adolescents, perceived barriers to and facilitating factors for use of PrEP in adolescents, and clinician-reported likelihood of prescribing PrEP. Transcripts were analyzed using framework analysis. Overall, clinicians viewed PrEP as a time-limited intervention that is one part of a comprehensive approach to HIV prevention among adolescents. Perceived barriers to prescribing to minors included concerns about: confidentiality, legality of minors consenting to PrEP without parental involvement, ability of minors to understand the risks/benefits of PrEP, the possible impact of PrEP on bone accrual, off-label use of PrEP medication in minors, and the high costs associated with PrEP use. Clinician-reported facilitating factors for prescribing PrEP to youth included educating communities and other clinicians about PrEP, ensuring adequate financial resources and infrastructure for delivering PrEP, developing formal guidance on effective behavioral interventions that should be delivered with PrEP, and gaining personal experience with prescribing PrEP. Clinicians indicated greater comfort with prescribing PrEP to adults versus minors. For PrEP to become more widely available to youth at risk for HIV infection, barriers that are unique to PrEP use in minors must be addressed.
authors.affiliation: 1 Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.|2 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio.
authors.forename: Tanya L Kowalczyk
authors.initials: TL
authors.lastname: Mullins
authors.affiliation: 3 Division of Adolescent Medicine, Indiana University , Indianapolis, Indiana.
authors.forename: Gregory
authors.initials: G
authors.lastname: Zimet
authors.affiliation: 4 Division of Infectious Diseases, Department of Medicine, Lifespan Hospital System/Alpert Medical School of Brown University , Providence, Rhode Island.|5 Providence Veterans Affairs Medical Center , Providence, Rhode Island.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lally
authors.affiliation: 1 Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.|2 Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Kahn
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010465:Perception; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D036301:Qualitative Research; D021841:Safe Sex; D014481:United States
chemical_list: D019380:Anti-HIV Agents