186. Attitudes Toward HIV Pre-Exposure Prophylaxis In A Sample of Adolescents And Young Adults Attending A U.S. Urban Primary Care Clinic

Abstract

HIV pre-exposure prophylaxis (PrEP) is a once-daily pill that can reduce infection risk by up to 99% and empower users to promote their sexual health and psychological well-being. Among adolescents and young adults (AYAs) who are racial/ethnic and sexual minorities, uptake of PrEP has been poor and understudied in real-world settings such as pediatric/adolescent primary care clinics. The objective of this study is to elucidate barriers and facilitators to PrEP initiation among at-risk AYA attending an urban U.S. primary care clinic. Sexually-active AYAs who were ever eligible for HIV testing were invited to complete an anonymous 19-question survey about PrEP awareness, interest in taking PrEP after learning about the “daily pill that can protect against HIV,” and intention to discuss PrEP with a peer navigator that day. Bivariate and multivariable Poisson regressions were conducted to gauge response differences by age (14-19 or 20-24), gender (male or female), sexuality (heterosexual or gay/bisexual/lesbian), clinic visit type (primary care, acute, or STI testing/treatment), and PrEP awareness (aware or not). Data were analyzed using STATA 15 ®. 73 AYAs were surveyed. Most respondents were 14-19 (63%), African-American (97%), female (70%), heterosexual (84%), and visiting for primary care (57%). One-fourth were aware of PrEP and 58% (n=42) reported they were interested in taking PrEP. The most common reasons for interest in PrEP included lowering HIV risk (95%) and reducing anxiety about sex (26%). The most common reasons for not being interested included perceiving low HIV risk (52%), believing they could not take PrEP every day (35%), knowing too little about PrEP (35%), and being concerned about side effects (29%). Among those who were interested in PrEP, 43% (n=16) indicated that they were willing to discuss PrEP with a navigator, however few (n=3) ultimately did. Multivariable Poisson regression analysis indicated that 14–19-year-olds had nearly 3-times greater likelihood of PrEP awareness compared to 20–24-year-olds (IRR=2.9, 95% CI=1.1–7.6, p=0.03), and that gay/bisexual/lesbian respondents had nearly 4-times greater likelihood of awareness compared to heterosexual respondents (IRR=3.6, 95% CI=1.7–7.5, p<0.01). AYAs aged 14-19 had 2-times greater likelihood of being interested in taking PrEP than their 20-24-year-old peers (IRR=2.3, 95% CI=1.1–4.8, p=0.02). No characteristics were associated with meeting a PrEP provider. This study suggests that while younger and sexual minority AYAs are more aware of and interested in taking HIV PrEP, uptake of PrEP continues to be low among AYAs attending urban primary care settings. Low HIV risk perception, and low knowledge of and self-efficacy for prevention strategies like PrEP may be key factors that contribute to use in this population. Effective strategies to increase PrEP uptake must address AYAs’ real-world barriers to PrEP use, such as adhering to a daily pill and concerns about side effects, and simultaneously leverage AYAs’ desire to lower HIV risk and reduce anxiety about sex.