Healthcare and service provider perspectives on pre-exposure prophylaxis in young Australians

Introduction The Australian pharmaceutical benefits scheme (PBS) was changed on 15-January 2021 to provide people under 18-years access to government-subsidised pre-exposure prophylaxis (PrEP). This study investigated healthcare and service provider’s attitudes and practices in discussing PrEP and impacts to PrEP prescribing practices, and the differences in the provision of PrEP to young adults aged >18years compared to people aged <18 years. Methods An online cross-sectional survey, conducted February-November 2023, used purposive, convenience and snowball sampling to recruit healthcare providers eligible to prescribe PrEP (general practitioners (GPs), nurse practitioners (NPs)) and non-prescribing healthcare/service providers (sexual health nurses, HIV community workers) in Australia. Young people were split into three age groups for comparison between young adults (aged 18-24) and adolescents including those above (16-17-years) and below (<16-years) the age of consent in Australia. Cross-tabulation with Pearson’s chi-squared (chi2) and Fisher’s exact tests were performed to investigate sexual health and PrEP-related attitudes and practices. Results Of the 122 respondents, 40.2% (49/122) were nurses, 18.0% (22/122) GPs, 11.5% (14/122) HIV community workers, 11.5% (14/122) were another profession (including public health physician, LGBTIQA child and family practitioner, social worker, counsellor), 10.7% (13/122) were sexual health physicians, 6.6% (8/122) NPs and 2 were HIV specialists. Most (73.8%, 90/122) reported initiating PrEP conversations with 18–24-year-olds, compared to 13.1% (16/122) with those >16 years. Of the 48 (39.3%) eligible PrEP prescribers, 47.9%, (23/48) reported feeling ‘extremely/somewhat’ comfortable assessing PrEP eligibility, 41.7% (20/48) reported awareness of 2021 PBS changes, 18.8% (9/48) reported changes to prescribing practices. Prescribers were significantly more likely than non-prescribers to consider PrEP suitable (54.2% vs 35.8%, p<0.05) for clients <16-years. Conclusion Guidelines and prescribing criteria need to reflect current PBS eligibility for young people to support healthcare prescriber decision making in recommending and prescribing PrEP for young people where appropriate. Greater education, training and support is required for healthcare providers to improve provider confidence in discussing sexual health needs and recommending and prescribing PrEP to young people to optimise the possible benefits of access to sexual health services and PrEP in this priority sub-group.