HIV Preexposure Prophylaxis Prescriptions, Consent Laws, and Uptake Barriers Among Adolescents

HIV preexposure prophylaxis (PrEP) is a safe and effective way to reduce HIV acquisition and was approved for adolescents in 2018. We assessed whether states with minor consent laws (MCLs) allowing younger adolescents to receive PrEP without parental/guardian consent were associated with increased prescription fills.

A legal review classified whether states had MCLs. A negative binomial regression model using national all-payer pharmacy claims compared PrEP fills between minors (13-17 years) and majority-age adolescents (18-19 years) between states with and without MCLs from 2015 to 2021, among 15 states with the highest minor PrEP fills. Key informant interviews (n = 25 experts from 7 states) elicited context for interpreting statistical results.

On average, minors had lower PrEP fills than majority-age adolescents (incident rate ratio [IRR], 0.21; 95% CI, 0.17-0.24). However, the interaction term between MCL and age group was insignificant (IRR, 1.11; 95% CI, 0.91-1.36), indicating that age group differences were similar between MCL and non-MCL states. Experts described numerous barriers faced by adolescents in accessing PrEP, including confidentiality concerns, clinic access, stigma, providers' hesitancy to discuss sexual health with and prescribe PrEP to minors, limited information on PrEP in school-based sexual education, and health care literacy.

We did not find evidence that the gap in PrEP prescription fills between minor and majority-age adolescents was smaller among states with PrEP-inclusive MCLs. Strategies to address the numerous barriers in PrEP access experienced by adolescents may be needed.