Healthcare and service provider perspectives on pre-exposure prophylaxis for HIV among young Australians

The Australian Pharmaceutical Benefits Scheme was changed on 15 January 2021 to provide people aged <18 years access to government-subsidised pre-exposure prophylaxis (PrEP) for HIV. This study investigated healthcare and service providers' attitudes and practices in discussing PrEP and impacts on PrEP prescribing practices, and the differences in the provision of PrEP to young adults aged >18 years compared with people aged <18 years.

An online cross-sectional survey, conducted February to November 2023, used purposive, convenience and snowball sampling to recruit healthcare providers eligible to prescribe PrEP (GPs, nurse practitioners) and non-prescribing healthcare/service providers (sexual health nurses, HIV community workers) in Australia. Young people were split into three age groups for comparison between young adults (aged 18-24 years) and adolescents, including those above (aged 16-17 years) and below (<16 years) the age of consent in Australia. Cross-tabulation with Pearson's chi-squared and Fisher's exact tests were performed to investigate sexual health and PrEP-related attitudes and practices.

Of the 122 respondents, 40.2% (49/122) were nurses, 18.0% (22/122) GPs, 11.5% (14/122) HIV community workers, 11.5% (14/122) were another profession (including public health physician, LGBTIQA child and family practitioner, social worker, counsellor), 10.7% (13/122) were sexual health physicians, 6.6% (8/122) nurse practitioners and two were HIV specialists. Most (73.8%, 90/122) reported initiating PrEP conversations with 18-24-year-olds, compared with 13.1% (16/122) with those aged >16 years. Of the 48 (39.3%) eligible PrEP prescribers, 47.9% (23/48) reported feeling 'extremely/somewhat' comfortable assessing PrEP eligibility, 41.7% (20/48) reported awareness of 2021 Pharmaceutical Benefits Scheme changes and 18.8% (9/48) reported changes to prescribing practices. Prescribers were significantly more likely than non-prescribers to consider PrEP suitable (54.2% vs 35.8%, P < 0.05) for clients aged <16 years.

Guidelines and prescribing criteria need to reflect current Pharmaceutical Benefits Scheme eligibility for young people to support healthcare prescriber decision-making in recommending and prescribing PrEP for HIV for young people where appropriate. Greater education, training and support is required for healthcare providers to improve provider confidence in discussing sexual health needs, and recommending and prescribing PrEP to young people to optimise the possible benefits of access to sexual health services and PrEP in this priority sub-group.