Initiation of HIV pre-exposure prophylaxis among youth in the United States, 2015–2018

ABSTRACT

Adolescents and young adults (“youth”) account for one-fifth of new HIV diagnoses in the U.S. HIV pre-exposure prophylaxis (PrEP), which became FDA approved in adolescents in May 2018, is highly effective at preventing HIV infection though there are limited data for PrEP initiation in youth. We aimed to quantify PrEP initiation and identify factors associated with PrEP initiation among youth at risk for HIV. We conducted a retrospective cohort study of youth aged 13–26 years who had an indication for PrEP between 1 January 2015, and 31 December 2018. We used data on commercially insured US individuals from the IBM MarketScan Commercial Database. We compared factors among youth who did and did not receive PrEP. We developed a multivariable logistic regression model to identify the association of all study covariates with receipt of PrEP. Among potentially PrEP eligible youth, only 2171 (1.6%) received a PrEP prescription in the year following their PrEP eligible claim. In multivariable models, youth who received PrEP were more likely to be older (adjusted odd ratio [aOR] for 18–20 year olds = 5.11; 95% CI = 3.35–7.77; aOR for 21–26 year olds = 16.90; 95% CI = 11.0–24.7), male (aOR = 92.42; 95% CI = 68.24–125), have sexual activity with elevated risk (aOR = 7.47; 95% CI = 6.50–8.60), or be diagnosed with gonorrhea or syphilis than youth who did not receive PrEP. Our findings highlight an opportunity to improve HIV prevention early in the life course.

KEYWORDS:

• HIV
• pre-exposure prophylaxis
• adolescents
• young adults
• inject drugs

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available IBM MarketScan. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from IBM Marketscan.

Ethics statement

The study was not considered human subjects research by the Boston University School of Medicine Institutional Review Board.

Additional information

Funding

This work was supported by the National Institutes of Health: National Institute on Drug Abuse [K01DA051684 and DP2DA051864 to J.A.B; K23DA045085 and L40DA042434 to S.E.H.].