| Autor: |
Mullins TLK; 1 Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.; 2 University of Cincinnati College of Medicine , Cincinnati, Ohio., Zimet G; 3 Section of Adolescent Medicine, Indiana University , Indianapolis, Indiana., Lally M; 4 Division of Infectious Diseases, Department of Medicine, Lifespan Hospital System/Alpert Medical School of Brown University , Providence, Rhode Island., Xu J; 5 Westat , Rockville, Maryland., Thornton S; 5 Westat , Rockville, Maryland., Kahn JA; 1 Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.; 2 University of Cincinnati College of Medicine , Cincinnati, Ohio. |
| Abstrakt: |
Pre-exposure prophylaxis (PrEP) is indicated for use in US adults, and little is known about clinician intentions to prescribe and actual prescription of PrEP to adolescents younger than 18. Fifty-six clinicians who care for HIV-infected and at-risk youth completed an anonymous online survey in 2014. Primary outcomes were (1) intentions to prescribe PrEP to adolescents and adults in four risk categories [men who have sex with men (MSM), transgender women, heterosexuals with multiple partners of unknown HIV status, heterosexuals with HIV-infected partners]; and (2) actual prescription of PrEP to adolescents and adults in these risk groups. Independent variables included clinician characteristics, experience prescribing nonoccupational postexposure prophylaxis, familiarity with and knowledge of PrEP and PrEP guidance, attitudes toward PrEP, and facilitating factors for prescribing PrEP and incorporation of PrEP guidance into practice. Variables associated with intention to prescribe ("very likely to prescribe" vs. other responses) and actual prescription of PrEP stratified by age and risk category were identified in logistic regression models. Mean age was 45.9 years (standard deviation 10.7); 64% were physicians. More clinicians reported high intention to prescribe PrEP to adult versus adolescent MSM (p = 0.02) and transgender women (p = 0.001). Variables associated with intention to prescribe and prescription of PrEP differed by age and risk category. In adolescents, those variables included positive beliefs, higher number of facilitating factors, and fewer barriers to PrEP prescription. Designing strategies based on these findings that address both facilitating factors and barriers to PrEP prescription may improve PrEP uptake by at-risk youth. |
