PHILADELPHIA — Is more outreach needed to increase uptake of HIV Pre-Exposure Prophylaxis (PrEP) within the VHA?
A new study led by the Corporal Michael J. Crescenz VAMC in Philadelphia suggested that is the case, pointing out, “U.S. Veterans Health Administration (VHA) remains modest, especially among younger women.”
The report in The Journal of Acquired Immune Deficiency Syndromes pointed out that younger women face a disproportionately high risk of HIV infection due to biological, behavioral and structural factors. They also have the greatest barriers to PrEP access compared to older women, according to the study team, which sought to examine gaps in PrEP delivery for the high-risk group.
To do that, the researchers conducted in-depth chart reviews of patients under age 26 identified as female at birth. Among all VHA patients prescribed PrEP from 2012-2022, they found only 24 who were under age 26 and PHILADELPHIA reviewed their charts. For each, a matched comparison patient under age 26 with a laboratory-confirmed gonorrhea or chlamydia diagnosis in the same year who had not been prescribed PrEP was selected.
Results indicated that nearly half (46%) of PrEP users were identified as transgender during chart review. Many (46%) initiated PrEP discussions with their providers, and 75% received prescriptions from infectious disease clinics. “The most common barrier observed was missed opportunities for providers to discuss PrEP—even after STI diagnoses,” the researchers said, adding, “Compared to PrEP users, non-PrEP users were more likely to have documented substance use, housing instability, sleep disturbances and post-traumatic stress disorder (PTSD) or anxiety.”
The study, which included participation from the VA Northeast Ohio Health Care System in Cleveland, concluded that the VHA needs to improve PrEP outreach, particularly for younger women and gender-diverse veterans. “Addressing missed opportunities, structural vulnerabilities, and provider engagement may enhance equitable access to PrEP within the VHA,” the authors wrote.
- Keddem S, Sorrentino A, Agha AZ, Colt SF, Dixon T, Caceres O, Van Epps P, Beste LA. Exploring PrEP Uptake in Young Women Veterans: Insights from a Detailed Chart Review within the Veterans Health Administration. J Acquir Immune Defic Syndr. 2025 Oct 24. doi: 10.1097/QAI.0000000000003782. Epub ahead of print. PMID: 41134619.
