O3022: Adolescents Prescribed Prep for HIV Prevention — United States, 2018–2021

Background: HIV pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention and was FDA-approved for use in adolescents in 2018. In 2019, persons aged 13–24 years accounted for 21% of the 36,801 diagnoses of HIV infection in the United States, highlighting the importance of prevention. Our objective was to describe PrEP use among adolescents in the United States since 2018.

Methods: We used a previously validated algorithm to identify adolescents aged 13–19 years who were prescribed PrEP in the national IQVIA prescription database from 2018 through the third quarter of 2021. We identified PrEP as a prescription for emtricitabine with tenofovir disoproxil fumarate or tenofovir alafenamide, without other antiretrovirals, for >28 days among persons without known diagnoses of HIV or hepatitis B. We described the annual number of younger adolescents (aged 13–17 years) and older adolescents (aged 18–19 years) prescribed PrEP by year, by sex and geographic region of residence, as well as the payer type and provider type for the prescriptions. Data on race and ethnicity were not described due to >75% missingness per year, and data on gender identify and sexual orientation were not available in IQVIA.

Results: From 2018 through the third quarter of 2021, the number of younger adolescents prescribed PrEP annually ranged 255–812 and the number of older adolescents ranged 1,342–4,239. The number of adolescents prescribed PrEP increased from 2018 to 2019, decreased in 2020, and increased again in 2021. Most adolescents prescribed PrEP were male, with a higher proportion of males among older adolescents (79.1%–85.6% annually) compared with younger adolescents (53.7%–66.0%), with little variation over time. The region of residence among younger and older adolescents were similar, with the highest proportion in the South (41.9% and 40.5% in 2021, respectively). There was a mix of payer types, with a higher proportion of public insurance among younger adolescents compared with older adolescents (51.5% vs. 32.5% in 2021). Among younger adolescents, more than half of prescribers were physicians (59.8% in 2021), with an increasing proportion of pediatricians over time (33.8% in 2018 to 52.7% in 2021). The most common prescriber physician specialty for older adolescents was family medicine or general practice (39.6% in 2021).

Conclusion: Increases in PrEP prescriptions for adolescents following FDA approval were disrupted by the COVID-19 pandemic in 2020, with encouraging increases in 2021. Male and female adolescents in all U.S. regions with various payers were prescribed PrEP during 2018–2021, with a smaller number of younger adolescents than older adolescents. Pediatric healthcare providers have an important role in HIV prevention by providing information about PrEP to all sexually active adolescents and prescribing PrEP for those who might benefit.