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Getting PrEP to Adolescents Before HIV Gets Them

Emtricitabine/tenofovir (aka FTC/TDF, or Truvada®) became an official part of the HIV prevention toolkit for adults (>18 years old) in the summer of 2012 (it seems so long ago already…), after the FDA approved it for daily pre-exposure prophylaxis (PrEP) on the basis of several large randomized controlled trials showing a greater than 90% reduction in HIV infections if taken daily.

Besides good biologic efficacy, PrEP has the advantage of being entirely controlled by the user (i.e., you don’t have to depend on your partner’s willingness to use a condom, knowledge of his/her HIV status, or undetectable viral load if HIV infected); and it is taken every day, not just when you are about to have sex (when we know people aren’t at their most…rational). It isn’t cheap, but as the first highly effective HIV prevention tool in decades, PrEP is covered by most expanded Medicaid programs, and many commercial insurance programs, including ACA plans, with varying copays. For insured patients with high copays, there are copay assistance programs specifically for PrEP, and for those without insurance, the drug manufacturer will pay the entire cost of the drug for low-income persons.

That’s all well and good. If you are over 18.

FDA hasn’t yet approved FTC/TDF PrEP for those younger than 18, even though we know that young men who have sex with men (YMSM) and transwomen are at very high risk of HIV infection and need effective HIV prevention tools, in addition to condoms. This means that it’s hard to find clinicians who will prescribe PrEP to adolescents, and for adolescents to find insurance coverage or payment assistance for PrEP.

There’s no medical reason to think it wouldn’t work: Many HIV-infected adolescents safely include FTC/TDF as part of their full-strength antiretroviral therapy, at the adult dose, as long as they weigh >35kg and have a Sexual Maturity Rating of 4 or higher (usually above 13 years). And a number of pioneering organizations around the country are finding innovative ways to address the main issues surrounding PrEP for Adolescents—adherence, retention/persistence, implementation models, payment, parental consent, provider attitudes, and confidentiality—so that youth can access PrEP and remain HIV-uninfected. Sign up for our webinar, on February 9th at 11am PST, to learn how Adolescent PrEP providers in San Francisco, Oakland, and Philadelphia are doing this important work.

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