🏳️‍🌈✝️ Why Are Physicians Reluctant to Prescribe PrEP to Adolescents?

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Although Truvada as PrEP is not approved for those under 18, it may be prescribed off-label—but many doctors are wary.

June 15, 2017


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Interviews with various Midwest physicians reveal a wariness to prescribe Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) to adolescents, aidsmap reports. Researchers believe this finding stresses the need to educate non-HIV-specialist medical providers about the potential benefits of PrEP to young people.

The U.S. Food and Drug Administration (FDA) has approved PrEP only for those 18 and older, so prescriptions to minors need to be off-label.

Researchers conducted in-depth interviews with 38 physicians who provide primary care to adolescents in the Midwest about their PrEP-related attitudes. The health care providers came from five different specialties—general pediatrics, family medicine, internal medicine, obstetrics and gynecology, and adolescent medicine.

Findings were presented at the 2017 Pediatric Academic Societies Meeting in San Francisco.

Seventy-nine percent of the physicians interviewed had treated patients with HIV. Thirty-seven percent said they were somewhat or very familiar with PrEP.

When asked about barriers that physicians may face when considering prescribing PrEP, the responses included: concern about patients’ adherence to the daily PrEP regimen and their ability to stick to the required quarterly follow-up schedule (these points were noted by a respective 30 and eight providers); concerns about safety and side effects (29 providers); disapproval from parents (17 providers); a provider’s lack of PrEP-related education (16 providers); the lack of FDA approval for use of PrEP among minors (13 providers); confidentiality concerns (nine providers); general concerns about prescribing medications to young people (nine providers); a lack of appropriate candidates for PrEP among their patients (six providers); and a lack of clarity about related legal issues (six providers).

Recent research suggests that adolescents may need monitoring as frequently as monthly to help them maintain good adherence to PrEP.

Forty-two percent of the clinicians said they were highly or somewhat likely to recommend PrEP to adolescent patients. However, just 34 percent said they were likely to actually prescribe Truvada as prevention to such individuals. Pediatricians were the most likely to recommend PrEP—63 percent said they would—but a slim minority of this group, 38 percent, said they would likely actually prescribe it. Internal medicine physicians were the least likely to recommend or prescribe PrEP—17 percent of the group fell into these categories on both counts.

To read the aidsmap article, click here.

Read more articles from POZ, here.