Background
Several oral and injectable PrEP medications are available in the United States, all of which are about 99% effective in preventing sexually acquired HIV when taken as prescribed. Adolescents and young adults are a key population that may benefit from PrEP as they account for approximately 20% of new HIV diagnoses. Each PrEP medication offers different benefits, for example tenofovir alafenamide and emtricitabine (TAF/FTC), approved in October 2019, has shown less impact on bone density compared to tenofovir disoproxil fumarate/FTC (TDF/FTC), available since July 2012. Limited information has been available on the use of different PrEP medications by adolescents and young adults. This information is important to monitor PrEP use in this population. Our objective was to analyze a national pharmacy database to estimate trends in US prescriptions for oral and injectable PrEP medications among adolescents and young adults from 2019 to 2023.
Methods
We analyzed IQVIA Real-World Data — Longitudinal Prescription Database using a validated algorithm to identify persons aged 13–24 years prescribed PrEP. We estimated the number of adolescents (aged 13–19 years) and young adults (aged 20–24 years) prescribed branded or generic FTC/TDF, branded FTC/TAF, or long-acting injectable cabotegravir (CAB-LA) during 2019–2023.
Results
The annual number of adolescents and young adults prescribed PrEP increased from 14,209 in 2019 to 66,612 in 2023. Branded FTC/TDF was the predominant PrEP medication prescribed for both adolescents and young adults until 2021, when generic FTC/TDF became the predominant medication prescribed (Figure). In 2023, 68,840 (97.7%) adolescents and young adults were prescribed oral PrEP compared to 1,591 (2.3%) prescribed injectable PrEP. The number of persons prescribed injectable PrEP more than doubled between 2022 and 2023 (680 to 1,591). In 2023, generic FTC/TDF was the most prescribed PrEP medication for both adolescents and young adults, representing 6,083 (62.6%) and 35,457 (57.9%) of prescriptions, respectively, followed by branded FTC/TAF (2,910, 29.9%;21,501, 35.1%; respectively).
Conclusions
PrEP use has increased among adolescents and young adults from 2019 to 2023. Injectable PrEP use among adolescents and young adults was low compared with oral medication, though its use has increased slightly since it has become available. Increasing PrEP use among young people who would benefit from it remains important to address the HIV epidemic.
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