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Preventing HIV among adolescents with oral PrEP: observations and challenges in the United States and South Africa
Open accessAbstract
Introduction: Adolescents and young adults aged <25 are a key population in the HIV epidemic, with very high HIV incidence rates in many geographic settings and a large number who have limited access to prevention services. Thus, any biomedical HIV prevention approach should prepare licensure and implementation strategies for young populations. Oral pre‐exposure prophylaxis (PrEP) is the first antiretroviral‐based prevention intervention with proven efficacy across many settings and populations, and regulatory and policy approvals at global and national levels are occurring rapidly. We discuss available data from studies in the United States and South Africa on the use of oral PrEP for HIV prevention in adolescent minors, along with some of the implementation challenges. Discussion: Ongoing studies in the United States and South Africa among youth under the age of 18 should provide the safety data needed by the end of 2016 to contribute to licensure of Truvada as daily PrEP in adolescents. The challenges of completing these studies as well as foreseeable broader challenges highlighted by this work are presented. Adherence to daily PrEP is a greater challenge for younger populations, and poor adherence was associated with decreased efficacy in all PrEP trials. Individual‐level barriers include limited familiarity with antiretroviral‐based prevention, stigma, product storage, and social support. Structural challenges include healthcare financing for PrEP, clinician acceptability and comfort with PrEP delivery, and the limited youth‐friendly health services available. These challenges are discussed in the context of the work done to date in the United States and South Africa, but will likely be magnified in the setting of limited resources in many other countries that are heavily impacted by HIV. Conclusions: Adolescent populations are particularly vulnerable to HIV, and oral PrEP in these populations is likely to have an impact on population‐level HIV incidence. The challenges of disseminating an HIV biomedical prevention tool requiring daily usage in adolescents are formidable, but addressing these issues and starting dialogues will lay the groundwork for the many other HIV prevention tools now being developed and tested.
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“Given that state laws and regulations vary in terms of parental consent requirements for medical services, PrEP implementation in this new population requires different strategies and research that can inform effective delivery [35–37].”
From “Scaling-out” evidence-based interventions to new populations or new health care delivery systems (2017) · cites this paper as [37]
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Metadata
- Authors
- Hosek, S., Celum, C., Wilson, C. M., Kapogiannis, B., Delany‐Moretlwe, S., & Bekker, L.
- Affiliations
- John H. Stroger, Jr. Hospital of Cook County (US)
- University of Washington (US)
- University of Alabama at Birmingham (US)
- National Institutes of Health (US)
- University of Cape Town (ZA)
- Corresponding author
- Hosek, Sybil
- Venue
- Journal of the International AIDS Society
- Publisher
- Wiley
- Published
- 2016-10
- Volume
- 19
- Issue
- 7S6
- Pages
- 21107-21107
- ISSN
- 1758-2652 (ISSN-L)
- PMC
- PMC5071778
- OpenAlex
- W2536440088
- Cited by
- 138
- References
- 32
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 19 · 2021: 28 · 2020: 14 · 2019: 19 · 2018: 17 · 2017: 12 · 2016: 2
- FWCI
- 15.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of the International AIDS Society (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Adolescent Sexual and Reproductive Health
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Keywords
- HIV prevention, oral pre-exposure prophylaxis, adolescents, Truvada, PrEP adherence, youth-friendly health services, HIV stigma, health care financing, clinician acceptability, HIV incidence, United States, South Africa
- MeSH terms
- Adolescent, Adult, Delivery of Health Care, Female, Humans, Male, South Africa, United States, HIV Infections, Anti-HIV Agents, Young Adult, Social Stigma, Pre-Exposure Prophylaxis
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