Research Spotlight: Preventive HIV Drugs Underprescribed to Young Women at Increased Risk

Anne Neilan, MD, MPH, of the Medical Practice Evaluation Center (MPEC) and Department of Medicine at Mass General Brigham, and Kevin Ard, MD, MPH, also of the Department of Medicine, are the lead and senior authors of a paper published in Sexually Transmitted Diseases, “Differences in Sexual Health Clinic Services by Age and Gender in Metropolitan Boston.”

Q: How would you summarize your study for a lay audience?

Although adolescents and young adults comprise only one quarter of the sexually active population in the United States, approximately half of new sexually transmitted infections (STIs) are diagnosed in people of these ages. Compared to older adults, little is known about how teens and young adults access and use services like STI screening and treatment, sexual health vaccinations and HIV pre-exposure prophylaxis (PrEP). PrEP is a preventive medicine for people who do not have HIV but are at increased risk of exposure.

Our study examined how people of different ages and genders used sexual health services in a Boston-based clinic that provides free, comprehensive services across six hospital- and community-based sites. While our study focused on a single metropolitan area, our findings reflect broader national challenges in sexual health service utilization.

Q: What question were you investigating?

We set out to learn whether adolescents and young adults who interacted with the Massachusetts General Hospital Sexual Health Clinic utilized sexual health services differently than older adults. We also aimed to identify opportunities to increase patient engagement and deliver existing services more consistently and equitably to those who need them most.

Q: What methods or approach did you use?

We analyzed data from 7,949 visits to the Sexual Health Clinic, made by 4,004 individuals, between January 2019 to June 2021. We grouped data on visits, STI diagnoses, PrEP use and health insurance by age and gender. We then used statistical analysis to examine how outcomes—such as being prescribed preventive PrEP—were associated with factors like age and gender.

Q: What did you find?

We found that among patients at increased risk for HIV exposure, PrEP prescribing differed by age and gender. For example, cisgender males who were 26 years old or under with PrEP indications were prescribed the medicine at slightly higher rates (86%) than their counterparts over age 26 (83%). However, among cisgender females at increased risk, only 20% of those at or under age 26 were prescribed PrEP compared to 72% of those over age 26.

Looking at the data from another angle, we discovered that young cisgender females (at or under age 26) were 63% less likely to be prescribed PrEP during their visits than young cisgender males. Additionally, only 17% of visits attended by even younger cisgender females (under age 22) who were candidates for PrEP received it.

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Q: What are the implications?

Addressing disparities by age, gender and race/ethnicity in HIV prevention—via PrEP prescriptions—is critical. Significant gaps for young cisgender females with PrEP indications reflect opportunities for improved programming tailored to this population, with the potential to avert new HIV diagnoses.

Gaps between PrEP need and prescription may also reflect patient preferences or other barriers such as the need for quarterly visits for oral PrEP or anticipated costs. They could also reflect provider-related barriers, such as limited knowledge of the drug or failure to consider PrEP for individuals other than men who have sex with men. Policy efforts focused on alleviating these barriers may help reduce HIV incidence by improving how well PrEP reaches those who would benefit from it.

Q: What are the next steps?

Future work should explore why PrEP prescription rates among young cisgender females are much lower than their counterparts, as well as evaluate targeted interventions to improve PrEP access for indicated young women.

Authorship: In addition to Neilan and Ard, Mass General Brigham authors include Yiqi Qian, Grace Chamberlin, Scott E. Hadland, Madhava Narasimhadevara, Vandana Madhavan and Fatma M. Shebl.

Paper cited: Neilan, A., et al. “Differences in Sexual Health Clinic Services by Age and Gender in Metropolitan Boston.” Sexually Transmitted Diseases. DOI: 10.1097/OLQ.0000000000002275

Funding: This work was supported by the Morton N. Swartz Transformative Scholar Award in Infectious Diseases, the Claflin Distinguished Scholars Award and the Eunice Kennedy Shriver National Institute for Child Health and Human Development (K08 HD094638-S).

Disclosures: None.