984. HIV Pre-Exposure Prophylaxis (PrEP) Prescription Rates Among Adolescents and Young adults (AYAs) at an Urban Academic Medical Center in Newark, NJ from 2017-2019: A Quality Assessment of HIV Prevention for High Risk Youth within the Epicenter of the NJ HIV Epidemic
Authors: Paer Jeffrey M , Mattappallil Arun , Bentsianov Sari , Finkel Diana 
Published: January 2021

Abstract

Background
In 2017, 21% of new HIV diagnoses occurred in AYAs (ages 13-24), disproportionately among black and Hispanic men who have sex with men (MSM). However, only 0.1-1.5% and 9.5-15.4% of national PrEP prescriptions have been provided to AYAs under 18 and 24, respectively, with a white male majority. In 2018, PrEP was approved for use in adolescents weighing more than 35kg. However, limited studies on attitudes of AYA providers suggest lack of familiarity of PrEP and concerns about adherence, safety, confidentiality, and cost have led to a slow uptake among AYAs. Here we describe the AYA PrEP prescription rates at Rutgers New Jersey Medical School (NJMS) in two unique practices, the Infectious Disease Practice (IDP) and Division of Adolescent and Young Adult Medicine (DAYAM).

Methods
Medical records were queried for patients prescribed Truvada for PrEP at NJMS from 2017-2019 to assess the specialty-specific prescription rates and demographics of AYAs on PrEP.

Results
Of the 273 patients who were prescribed PrEP from 2017-2019, 2.2% (n=6) and 20.5% (n=56) were under 18 and 24, respectively. IDP and DAYAM respectively prescribed PrEP to 62.5% (n=35) and 33.9% (n=19) of AYAs. Among all AYAs on PrEP, 71.4% were black, 21.4% Hispanic, 19.6% transgender women (TGW), and 85.7% MSM or TGW who have sex with men. Most (73.7%) AYAs at DAYAM received PrEP from their primary care providers (PCP) compared to only 5.7% at IDP.
Table 1. Department-specific characteristics of (A) patients of all ages and (B) AYAs prescribed PrEP at NJMS between 2017-2019, n (%).

Fig. 1-3. Annual percentage of (1) patients receiving PrEP at NJMS by age group and (2) AYAs receiving PrEP by department, and (3) percentage of AYAs prescribed PrEP by their PCP, 2017-2019.

Fig. 4. Percentage of AYAs prescribed PrEP at NJMS between 2017-2019 by (A) race, (B) gender identity, and (C) HIV transmission risk factor, % (n).

Conclusion
AYA PrEP prescription rates at NJMS were higher than national estimates, primarily driven by IDP and DAYAM, in contrast to national data identifying emergency, family and internal medicine providers as common AYA PrEP prescribers. Compared to national data, our AYAs on PrEP better reflected the national PrEP indications by race and HIV risk factor (although intravenous drug use was not identified as a PrEP indication in our study presumably due to a lack of forthcomingness). IDP and DAYAM routinely identify high risk AYAs, screen for PrEP eligibility using detailed, nonjudgmental sexual histories, and prescribe PrEP to AYAs. It is thus important to integrate primary care into subspecialty clinics with an emphasis on including PrEP in routine sexual/reproductive health services. PCPs in other fields should expand AYA PrEP prescriptions to further engage high risk youth in HIV prevention.

Disclosures
All Authors: No reported disclosures