Discussion and Initiation of HIV Pre-exposure Prophylaxis Were Rare Following Diagnoses of Sexually Transmitted Infections Among Veterans

Background Healthcare encounters for the diagnosis and treatment of sexually transmitted infections (STIs) are common and represent an opportunity to discuss and initiate HIV pre-exposure prophylaxis (PrEP). Little is known about how frequently PrEP is discussed and initiated in association with enc...

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Published in:Journal of general internal medicine : JGIM 2022-08, Vol.37 (10), p.2482-2488
Main Authors: Kobayashi, Takaaki, Van Epps, Puja, Maier, Marissa M, Beste, Lauren A, Beck, Brice F, Alexander, Bruce, Ohl, Michael E
Format: Article
Language:English
Subjects:
Case-Control Studies
Control charts
Diagnosis
Disease prevention
Gonorrhea
Health care
HIV
HIV Infections - diagnosis
HIV Infections - epidemiology
HIV Infections - prevention & control
Homosexuality, Male
Human immunodeficiency virus
Humans
Infections
Initiators
Internal Medicine
Male
Medical diagnosis
Medicine
Medicine & Public Health
Original Research
Patients
Pre-Exposure Prophylaxis
Prophylaxis
Retrospective Studies
Sexually transmitted diseases
Sexually Transmitted Diseases - diagnosis
Sexually Transmitted Diseases - epidemiology
Sexually Transmitted Diseases - prevention & control
STD
Syphilis
Syphilis - diagnosis
Syphilis - epidemiology
Syphilis - prevention & control
Veterans
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Summary:Background Healthcare encounters for the diagnosis and treatment of sexually transmitted infections (STIs) are common and represent an opportunity to discuss and initiate HIV pre-exposure prophylaxis (PrEP). Little is known about how frequently PrEP is discussed and initiated in association with encounters for STIs. Design Retrospective cohort and nested case-control study, matched by STI date, in national Veterans Health Administration (VHA) facilities  from January 2013 to December 2018. Participants Veterans with a first STI diagnosis (i.e., early syphilis, gonorrhea, or chlamydia) based on ICD codes, excluding those with prior HIV diagnosis, prior PrEP use, or STI diagnosed on screening during a visit to initiate PrEP. Main Measures Frequency of PrEP initiation within 90 days of healthcare encounter for STIs. In the case-control study, we performed a structured chart review from the initial STI-related clinical encounter and quantified frequency of PrEP discussions among matched patients who did and did not initiate PrEP in the following 90 days. Key Results We identified 23,312 patients with a first STI, of whom 90 (0.4%) started PrEP within 90 days. PrEP initiation was associated with urban residence (OR = 5.0, 95% CI 1.8–13.5), White compared to Black race (OR = 1.7, 95% CI 1.0–2.7), and syphilis diagnosis (OR = 5.7, 95% CI 3.7–8.6). Chart review revealed that discussion of PrEP was rare among people with STIs who did not subsequently start PrEP (1.1%, 95% CI 0.1–4.0). PrEP initiation was associated with documentation of sexual history (80.0% of initiators vs. 51.0% of non-initiators, p < 0.01) and discussion of PrEP (52.2% vs. 1.1%, p < 0.01) during the initial STI diagnosis encounter. Conclusions Discussion and initiation of PrEP were rare following healthcare encounters for STIs. Interventions are needed to improve low rates of sexual history-taking and discussion of PrEP during healthcare encounters for STIs.
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-021-07034-7