Response to: Implementation Facilitators and Barriers for Primary Care Providers Prescribing Daily Oral PrEP to Adolescents in the United States (re: DOI: 10.1089/apc.2023.0090)

To the Editor:

Iread “Implementation Facilitators and Barriers for Primary Care Providers Prescribing Daily Oral Prep to Adolescents in the United States” by Owens et al. ¹ 2023 with enthusiasm. Awareness of sexual knowledge among this age group is of great importance due to their susceptibility to HIV. The authors reported that facilitators to primary care providers (PCP) prescribing daily oral preexposure prophylaxis (PrEP) were associated with accessible educational material, parents' support, and the availability of PrEP medication. Barriers to PCP prescribing daily oral PrEP included a lack of liability laws, unsupportive parents, limitations on minor consent, privacy protections, high costs for PrEP care, and hurdles with insurance companies. Other barriers included adolescent's ineligibility for PrEP or failing to adhere to daily PrEP, missed follow-up appointments, and medication availability in local clinics or pharmacies.

However, there are two points that I believe are important to consider that were not included in the article. First, the study did not mention the importance of the biological, physical, mental, and social factors that take place in an adolescent during this transition process from childhood to adulthood. During this transition phase, the adolescents' brain and body are in a physical and active development. Adapting to these changes can affect their behavior and their emotions; therefore, they can act with acceptance, or they can neglect the changes and act as an independent individual. In the same way, independence, judgment, and stigma can influence the acceptance of the treatment to PrEP. A PCP that is aware of all these challenges during this transition stage, can better convey the importance of the treatment and its adherence. ²

Second, although the study focuses on PCP, it does not take into consideration the support a multidisciplinary team can bring to the adolescent and their family members. There is a need to involve in this process health care providers that include the nurse, therapist, and social workers that are properly trained and educated on this age group. A strong multidisciplinary team can enable comfortable and effective communication between adolescents and their providers. They can also help build a safe environment during the screening process and identify any possible risk factors that can affect the treatment and its compliance. ^3,4 In conclusion, it is important to understand the developmental challenges facing adolescents and the role that multidisciplinary teams play in facilitating Oral PrEP delivery to adolescents.