Journal article
Discussion and Initiation of HIV Pre-exposure Prophylaxis Were Rare Following Diagnoses of Sexually Transmitted Infections Among Veterans
Journal of general internal medicine : JGIM, Vol.37(10), pp.2482-2488
08/01/2022
DOI: 10.1007/s11606-021-07034-7
PMCID: PMC9360206
PMID: 34341917
Abstract
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. (c) This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2021
Details
- Title: Subtitle
- Discussion and Initiation of HIV Pre-exposure Prophylaxis Were Rare Following Diagnoses of Sexually Transmitted Infections Among Veterans
- Creators
- Takaaki Kobayashi - University of IowaPuja Van Epps - Case Western Reserve UniversityMarissa M. Maier - Oregon Health & Science UniversityLauren A. Beste - University of WashingtonBrice F. Beck - Iowa City VA Health Care SystemBruce Alexander - Iowa City VA Health Care SystemMichael E. Ohl - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.37(10), pp.2482-2488
- DOI
- 10.1007/s11606-021-07034-7
- PMID
- 34341917
- PMCID
- PMC9360206
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Publisher
- Springer Nature
- Number of pages
- 7
- Grant note
- 7351 / Veterans Affairs Office of Rural Health
- Language
- English
- Date published
- 08/01/2022
- Academic Unit
- Pharmacy; Psychiatry; Infectious Diseases; Internal Medicine
- Record Identifier
- 9984359770902771
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