In the United States, youth experience suboptimal HIV pre-exposure prophylaxis (PrEP) adherence. One common idea posits that this is due to their developing decision-making skills. However, quantitative evidence of this assumption is limited. We therefore examined whether individual decision-making factors, such as HIV risk perception and sexual behavior, predicted PrEP adherence in a national trial of young sexual and gender minorities (YSGMs). In 2019–2021, the Adolescent Medicine Trials Network for HIV Interventions 142 study enrolled 225 PrEP users (ages 16–24) throughout the country. Regression models estimated the associations between HIV risk perception (using a modified Perceived HIV Risk Scale), sexual behavior (condomless anal sex in ≤ 3 months), and self-reported oral PrEP adherence (≥4 pills in the past week) at the same time point (baseline) and longitudinally (3 months). Baseline risk perception (risk ratio [RR]: 0.92, 95% confidence interval [CI]: 0.82, 1.04) and condomless anal sex (RR: 1.10, 95% CI: 0.97, 1.25) were not associated with PrEP adherence at the same time point and did not predict 3-month adherence (RR: 0.97, 95% CI: 0.85, 1.11; RR: 1.05, 95% CI: 0.93, 1.19, respectively). Baseline risk perception was not associated with condomless anal sex at either time point (baseline RR: 1.16, 95% CI: 0.94, 1.43; 3-month RR: 1.07, 95% CI: 0.90, 1.28). In this national trial of YSGM, HIV risk perception and condomless anal sex did not predict PrEP adherence. Targeting individual-level perceptions and behaviors will likely insufficiently address youth's suboptimal PrEP use. Future research should identify YSGM-specific adherence drivers and train providers to recognize such motivations.

中文翻译：

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美国年轻性少数群体和性别少数群体的艾滋病毒风险认知、性行为和暴露前预防依从性之间的不一致


在美国，青少年的艾滋病毒暴露前预防 (PrEP) 依从性不佳。一种常见的观点认为，这是由于他们的决策能力不断发展。然而，这一假设的定量证据是有限的。因此，我们在一项针对年轻性少数群体 (YSGM) 的全国试验中研究了个人决策因素（例如 HIV 风险认知和性行为）是否可以预测 PrEP 依从性。 2019-2021 年，艾滋病毒干预青少年医学试验网络 142 研究在全国招募了 225 名 PrEP 用户（16-24 岁）。回归模型估计了 HIV 风险感知（使用修改后的 HIV 感知风险量表）、性行为（≤ 3 个月内的无套肛交）和自我报告的口服 PrEP 依从性（过去一周≥4 粒药片）之间的关联。时间点（基线）和纵向（3 个月）。基线风险感知（风险比 [RR]：0.92，95% 置信区间 [CI]：0.82，1.04）和无套肛交（RR：1.10，95% CI：0.97，1.25）与 PrEP 依从性无关时间点，并没有预测 3 个月的依从性（分别为 RR：0.97，95% CI：0.85，1.11；RR：1.05，95% CI：0.93，1.19）。在任一时间点，基线风险认知均与无套肛交无关（基线 RR：1.16，95% CI：0.94，1.43；3 个月 RR：1.07，95% CI：0.90，1.28）。在 YSGM 的这项全国试验中，HIV 风险认知和无套肛交并不能预测 PrEP 依从性。针对个人层面的看法和行为可能不足以解决青年人未达到最佳使用 PrEP 的问题。未来的研究应该确定 YSGM 特定的遵守驱动因素并培训提供者认识到这些动机。