Among 2590 US adolescents using PrEP, 83.5% are girls, 59% on Medicaid
22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018


Mark Mascolini

A nationwide US analysis determined that, among 2590 youngsters 12 to 17 years old who used tenofovir/emtricitabine (Truvada) PrEP from 2012 through 2017, 83.5% were girls [1]. Most adolescents using PrEP, 59%, paid via Medicaid, the government health insurance for low-income people.

The United States, the European Union (EU), and at least 19 other countries have licensed Truvada PrEP for several years to prevent HIV infection in adults 18 or older. The European Union approved Truvada PrEP for adolescents weighing at least 35 kg in February 2018, and the United States followed suit in May 2018. Gilead investigators conducted this study to describe PrEP use by adolescents 12 to 17 years old in the US from January 2012 to December 2017.

The analysis relied on national pharmacy claims data from at least 80% of US retail pharmacies. Researchers used a validated algorithm to identify Truvada prescriptions for PrEP use--not for postexposure prophylaxis (PEP), chronic HIV therapy, or off-label treatment of hepatitis B virus infection. 

The number of 12- to 24-year-olds with a PrEP prescription varied from 1362 in 2012 (17% of all prescriptions) to 1969 (17.8%) in 2013, 3696 (15.1%) in 2014, 6663 (14.6%) in 2015, 5639 (13.8%) in 2016, and 8001 (16.9%) in 2017. Over those 6 years, the 2590 12-to-17-year-olds who started PrEP accounted for 9.5% of the 12-to-24-year-old PrEP-using population. Numbers and proportions of 12-to-17-year-olds with a PrEP prescription varied from 269 (19.8% of all PrEP-using youth) in 2012 to 818 (12.3%) in 2015. Then PrEP use by 12-to-17-year-olds dwindled to 222 (3.9% of youth) in 2016 and to 310 (3.9%) in 2017.

Across the study years, females accounted for 83.5% of PrEP prescriptions in the 12-to-17-year group. From age 19 through 24, women filled fewer than 40% of PrEP prescriptions. In the 12-to-17 group, 38% of PrEP prescriptions came from pediatricians, 21% from emergency medicine prescribers, and 13% from family practitioners. Girls 12 to 17 years old filled 22% of PrEP prescriptions in the emergency medicine, compared with 15% of boys.  

Medicaid covered PrEP prescriptions for 59% of 12-to-17-year-olds, compared with 22% of 18-to-24-year-olds and 13% of people 25 or older. 

The Gilead researchers did not speculate on why teen PrEP use is so much more prevalent in US girls than boys. Girls cannot be having that much more sex than boys, so girls must be more aware of protecting themselves through PrEP, more willing to protect themselves with antiretrovirals, or both. High reliance on Medicaid for PrEP coverage among US teens indicates that many of these youngsters live in low-income families. 

The investigators underlined "an important unmet need to improve awareness and engagement in HIV prevention for adolescents and young adults at risk for HIV." They suggested that recent US and EU approval of PrEP for adolescents could improve PrEP access in this age group. 

Reference
Magnuson D, Hawkins T, Mera R. Adolescent use of Truvada (FTC/TDF) for HIV pre-exposure prophylaxis (PrEP) in the United States (2012-2017). AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract TUAC0305.