Clinicians prescribing Truvada (tenofovir disoproxil fumarate/emtricitabine) or Descovy (tenofovir alafenamide/emtricitabine) as pre-exposure prophylaxis (PrEP) for adolescents may have to go the extra mile to provide the most effective support to help this population mitigate their risk of contracting HIV.
The Centers for Disease Control and Prevention (CDC) has published guidance for health care providers who prescribe PrEP to adolescents in its Morbidity and Mortality Weekly Report. The federal agency expresses confidence that this population can do well on the regimen given the proper support.
The Food and Drug Administration (FDA) approved Truvada for use as PrEP by adults in 2012. In 2018, the FDA then approved Truvada as PrEP for use among adolescents weighing at least 77 pounds who are at risk for HIV. In 2019, the agency approved Descovy as PrEP for adults and adolescents, excluding those at risk for HIV through vaginal sex due to a lack of clinical trial data regarding its use among cisgender women and trans men.
Health care providers prescribing PrEP to adolescents, the CDC states, must consider various factors unique to this group. This includes specifics about PrEP’s safety among young people, legal matters related to consent for clinical care and confidentiality, and the partnership between adolescents and their parents and guardians when it comes to their health care.
Clinicians also need to consider how to structure adolescents’ clinic visits, how best to support their adherence to the daily PrEP regimen and how to support the continued quarterly clinic visits required to maintain a prescription for Truvada or Descovy. Greater follow-up may be necessary to help young people with their adherence.
PrEP providers should know the relevant statutes and regulations about providing health care to minors in the states where they practice.
When it comes to making decisions about PrEP use, health care providers should engage in partnerships with adolescents and recognize their autonomy to the extent permitted by law. If safe and reasonable to do so, parents should be included in these discussions.
The CDC recommends considering PrEP as one possible component of comprehensive sexual and physical health care for adolescents who engage in sexual behaviors that put them at risk for HIV or who inject drugs.
“PrEP is a safe and effective intervention to reduce the risk for HIV acquisition,” the CDC concluded. “Adolescents should be screened for behaviors that put them at risk for acquiring HIV. In adolescents for whom PrEP is indicated, PrEP can be offered as part of a comprehensive approach tailored to their specific needs.”
To read the CDC report, click here.