Barriers to the uptake and sustained adherence to pre-exposure prophylaxis among adolescents and young people at risk of HIV acquisition: a systematic review of available evidence

Adolescents and young people remain disproportionately affected by HIV, yet uptake and sustained adherence to pre-exposure prophylaxis (PrEP) are suboptimal. Understanding barriers is essential to inform adolescent-specific prevention strategies. This review aimed to systematically synthesize evidence on barriers to PrEP uptake and sustained adherence among adolescents and young people at risk of HIV acquisition. We conducted a systematic review following a pre-registered PROSPERO protocol (CRD42024600891). PubMed, Scopus, Web of Science, and Google Scholar were searched for English-language studies published between 2012 and 2024. Eligible studies included adolescents and young people (10–24 years, extended to 25 years in three studies whose populations overlapped with the target group) at risk of HIV acquisition and reported barriers to PrEP uptake or adherence. Data were extracted independently by multiple reviewers and synthesized thematically. From 16,339 records screened, 16 studies met inclusion criteria. Studies were conducted in North America, Latin America, and sub-Saharan Africa. Reported barriers to PrEP uptake included stigma, low awareness, mistrust of providers, side effect concerns, and financial or access barriers. Barriers to sustained adherence included pill fatigue, side effects, transportation challenges, parental consent requirements, and negative healthcare provider attitudes. Adolescents and young people encounter multilevel barriers to PrEP uptake and adherence, spanning individual, interpersonal, and structural domains. Addressing stigma, strengthening provider training, reforming consent policies, and expanding youth-centred services are critical for optimizing PrEP delivery. Targeted interventions must consider adolescents’ developmental and socio-cultural contexts to maximize the impact of PrEP in reducing HIV incidence globally.