1273. Reasons for Disengagement in Care among Individuals Receiving Pre-Exposure Prophylaxis (PrEP) from a Sexual Health Clinic

Abstract Background Pre-exposure prophylaxis (PrEP) effectively reduces HIV acquisition, but its efficacy depends on continued engagement through periods of high and low risk. Persistence in HIV prevention care has been low in real-world settings. In our program, 32% of patients are lost to care after their first visit and only 35% of patients are retained at their planned third visit. Reasons for low persistence in care are poorly described. Methods We identified all MSM who started PrEP between July 2015 and June 2018 at a sexual health clinic in an urban academic medical center in New York and had not had a visit in ≥6 months. We called patients between July 2018 and January 2019; those who were English speaking were given the option to complete an online questionnaire about current PrEP status, reasons for disengagement, and social and behavioral determinants of health (SBDH). Results Up to 710 patients were eligible for the study; over 700 calls were made. 125 participants agreed to participate and 57 (46%) completed the questionnaire. 24 patients (42%) were still actively taking PrEP. The most common reasons for starting PrEP were fear of getting HIV (58%), high self-perceived HIV risk (28%), and recommendations from friends (26%). Among those no longer taking PrEP, the most common reasons for discontinuation were cost/insurance issues (32%), lower perceived HIV risk (18%), concern about long-term side effects (12%), and trouble attending every-3-month appointments (12%). For those stopping due to lower perceived risk, 40% were in a monogamous relationship, 60% were less sexually active, and 20% always used a condom or did not engage in receptive anal intercourse. 56% of patients had at least 1 major life event in the preceding 3 months, including loss of a job (25%), breakup with a partner (12%), illness or death of a family member (11%), or unstable housing (8%). 47% used drugs or alcohol before sex in the past month including 39% not on PrEP. Conclusion Reasons for engagement, disengagement, and re-engagement are highly variable at the individual level. Cost and insurance issues were common in spite if clinic resources available to cover the cost of visits and medications. Life trauma was common. Individualized interventions to address SBDH may be required to engage and retain individuals in HIV prevention care. Disclosures All authors: No reported disclosures.

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745. Operationalization of Comprehensive Sexual Wellness Clinic at a Large Urban Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.813 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S333-S333

Author(s):

Aniruddha Hazra ◽

Jessica Schmitt ◽

Alvie Bender ◽

Michelle Moore ◽

Cheryl Scott ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Sexual Health ◽

Social Services ◽

Medical Center ◽

Academic Medical Center ◽

Health Clinic ◽

Hiv Diagnosis ◽

Transmitted Infection ◽

Sexually Transmitted

Abstract Background Due to the closure of surrounding city-run sexually transmitted infection (STI) clinics, uninsured and underinsured patients living near an urban academic medical center have been relying on the Emergency Department (ED) for their sexual health needs. A novel Sexual Wellness Clinic (SWC) was created to provide comprehensive sexual healthcare and primary care linkage to patients presenting to the ED with STI complaints. Methods SWC-eligible patients are identified at ED intake and undergo a Medical Screening Exam (MSE) by a triage physician before transport to clinic. Notable exceptions to the SWC are patients who are pregnant, younger than 18 years of age, victims of sexual assault, or deemed to require higher acuity care. Once at the SWC, patients undergo a complete history and physical examination, comprehensive STI testing, and, if indicated, empiric treatment as well as same-day initiation of Pre-Exposure Prophylaxis (PrEP). Social services within the clinic also assist in arranging primary care follow-up either at the medical center or an affiliated Federally Qualified Health Center (FQHC). Results During its initial 8 weeks, 28 patients were seen in the SWC; 35.6% were cis-female and 64.2% were cis-male. All female patients identified as women who have sex with men, 89% of male patients identified as men who exclusively have sex with women. Patient ages ranged from 18 to 55 with a mean age of 25. Overall, 17.8% of patients tested positive for gonorrhea; 7.1% tested positive for chlamydia, and 0% tested positive for syphilis. One new HIV diagnosis was identified. Same-day PrEP was initiated in 28.5% of patients of which 62.5% (n = 5) were female and 37.5% (n = 3) were male. SWC linked 79% of patients to primary care. Conclusion We demonstrated the feasibility of this unique workflow bringing patients from the ED to a specialized sexual health clinic. The majority of patients visiting SWC identified as heterosexual men and women, which differs from other metropolitan STI clinics. Identifying these populations with untreated STIs and other HIV risk factors for targeted intervention is integral to local and national HIV elimination efforts. Disclosures All authors: No reported disclosures.

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Birth Cohort Variations Across Functional Knowledge of HIV Prevention Strategies, Perceived Risk, and HIV-Associated Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

American Journal of Men s Health ◽

10.1177/1557988318790875 ◽

2018 ◽

Vol 12 (6) ◽

pp. 1824-1834 ◽

Cited By ~ 4

Author(s):

Akshay Sharma ◽

Erin M. Kahle ◽

Stephen P. Sullivan ◽

Rob Stephenson

Keyword(s):

Hiv Prevention ◽

Birth Cohort ◽

Perceived Risk ◽

The United States ◽

Prevention Strategies ◽

The Past ◽

Hiv Prevention Strategies ◽

Functional Knowledge ◽

Sex With Men ◽

Exposure Prophylaxis

Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain heavily impacted by HIV. The purpose of this study was to describe intergenerational differences in functional knowledge of HIV prevention strategies, perceived risk, recent condomless anal sex (CAS), and HIV testing behavior. Eight hundred sexually active GBMSM were recruited via Facebook from August to September 2015, and administered a Web-based survey which included 12 multiple-choice questions to elicit data regarding functional knowledge of different HIV prevention approaches (e.g., condom use, pre-exposure prophylaxis post-exposure prophylaxis, treatment as prevention, circumcision). Cumulative logit and multivariable logistic models were formulated to examine birth cohort variations across four analytic outcomes. Younger generations were significantly more knowledgeable, as were GBMSM with higher education. Non-Hispanic non-White GBMSM and those reporting a bisexual/other sexual orientation had lower functional knowledge. Younger generations were equally concerned about contracting HIV as their older counterparts. Perceived risk was significantly higher among non-Hispanic non-White and Hispanic GBMSM, but lower among those with higher education and those in a relationship. Finally, birth cohort variations with respect to engaging in CAS with ≥2 men in the past 3 months and testing for HIV in the past year were not markedly pronounced. Younger GBMSM might be more knowledgeable about HIV prevention strategies compared to their predecessors, but are equally concerned about contracting HIV. Researchers and practitioners should consider intergenerational and other demographic differences while designing multifaceted HIV prevention programs for GBMSM.

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Lessons Learned from Longer Acting Reversible Contraception Applied to Longer Acting HIV Prevention Technologies

Current HIV/AIDS Reports ◽

10.1007/s11904-021-00571-0 ◽

2021 ◽

Author(s):

Rachel Logan ◽

Dominika Seidman

Keyword(s):

Hiv Prevention ◽

Reproductive Health ◽

Sexual Health ◽

Lessons Learned ◽

Reproductive Justice ◽

Holistic View ◽

Marginalized Communities ◽

Exposure Prophylaxis

Abstract Purpose of Review This review describes lessons learned from longer acting contraception and employs a reproductive justice lens to inform expansion of emerging HIV prevention technologies. Recent Findings Reproductive justice is a framework that advocates for the promotion of universal sexual and reproductive freedoms, particularly among historically marginalized communities. This framework takes a holistic view of individuals and sees the interconnections between sexual health, reproductive health, and overall health. Employing a sexual and reproductive justice perspective is essential to understanding and helping to mitigate the role intersecting structural, sexual, and reproductive oppressions, including those demonstrated through promotion of longer acting contraception, and can critically inform rollout of future prevention technologies, such as longer acting HIV pre-exposure prophylaxis. Summary This review highlights the need for researchers, clinicians, and policymakers to apply lessons learned from contraception and specifically focuses on principles of reproductive justice to offer expanding HIV prevention options.

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Fuckbuddy partnerships among men who have sex with men – a marker of sexually transmitted infection risk

International Journal of STD & AIDS ◽

10.1177/0956462417717647 ◽

2017 ◽

Vol 29 (1) ◽

pp. 44-50 ◽

Cited By ~ 2

Author(s):

Vincent J Cornelisse ◽

Christopher K Fairley ◽

Tiffany Phillips ◽

Sandra Walker ◽

Eric PF Chow

Keyword(s):

Sexual Health ◽

Health Centre ◽

Romantic Attachment ◽

Sexual Partners ◽

Health Clinic ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Hiv Prevention Strategies ◽

Sex With Men ◽

Exposure Prophylaxis

‘Fuckbuddies’ are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of ‘fuckbuddy’ partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as ‘fuckbuddies’. Most MSM (63%) with a ‘fuckbuddy’ had multiple ‘fuckbuddies’. MSM with ‘fuckbuddies’ were more likely to also have casual sexual partners (odds ratio [OR] 5.7; 95% confidence interval 3.6–8.9) and had more casual sexual partners (median of 4 versus 1, p < 0.001) and more rectal chlamydia (12.4% versus 5.7%; adjusted OR 2.3; p < 0.05) than MSM without ‘fuckbuddies’, and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with ‘fuckbuddies’ are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about ‘fuckbuddy’ partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).

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Pre-exposure prophylaxis prescribing and retention in care among heterosexual women at a community-based comprehensive sexual health clinic

AIDS Care ◽

10.1080/09540121.2017.1286287 ◽

2017 ◽

Vol 29 (7) ◽

pp. 866-869 ◽

Cited By ~ 17

Author(s):

Oni J. Blackstock ◽

Viraj V. Patel ◽

Uriel Felsen ◽

Connie Park ◽

Sachin Jain

Keyword(s):

Sexual Health ◽

Retention In Care ◽

Health Clinic ◽

Community Based ◽

Heterosexual Women ◽

Exposure Prophylaxis

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Sexual behaviour and HIV prevention needs of men attending a suburban Sex on Premises Venue

Sexual Health ◽

10.1071/sh14227 ◽

2015 ◽

Vol 12 (5) ◽

pp. 383 ◽

Cited By ~ 5

Author(s):

Anthony J. Santella ◽

Timothy E. Schlub ◽

Catriona Ooi ◽

Rick Varma ◽

Martin Holt ◽

...

Keyword(s):

Hiv Prevention ◽

Health Services ◽

Sexual Health ◽

General Practitioners ◽

Sexual Behaviour ◽

Consistent Condom ◽

Health Clinic ◽

Anal Sex ◽

Condom Usage ◽

Health Services Needs

Background Sexual behaviour and HIV prevention needs of men who have sex with men (MSM) attending suburban Sex on Premises Venues (SOPVs) are understudied. Methods: A cross-sectional survey examining sexual activity, health services utilisation, sexual health services needs and STI knowledge was conducted among MSM over 18 years old attending a SOPV in Western Sydney between June and July 2013. Results: A total of 213 MSM were sampled; approximately half of the respondents (51%) reported that they only had sex with other men, and 46% had sex with both men and women. Condom use varied considerably, with ~50% of responders not using condoms consistently during anal sex. Consistent condom usage was not associated with having regular, casual or a mix of regular and casual partners during anal sex (P = 0.09). The majority (59.5%) obtained sexual health screening services from general practitioners; only 15.0% sought services from a local sexual health clinic. Over half of respondents (57.7%) believed that SOPVs should offer on-site and free testing services. Those with the highest level of previous STI diagnoses were gay men (41%), those who only had casual partners (38%) and those who did not complete high school (65%). Conclusions: Sexual health services and non-government organisations should consider targeting bisexual men with rapid HIV testing and condom usage campaigns. Low cost or free on-site HIV and STI testing at SOPVs and stronger partnerships between general practitioners and sexual health services are needed.

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HIV Pre-exposure Prophylaxis (PrEP) Uptake and Retention Among Men Who Have Sex with Men in a Community-Based Sexual Health Clinic

AIDS and Behavior ◽

10.1007/s10461-017-2009-x ◽

2017 ◽

Vol 22 (4) ◽

pp. 1096-1099 ◽

Cited By ~ 57

Author(s):

J. Carlo Hojilla ◽

David Vlahov ◽

Pierre-Cedric Crouch ◽

Carol Dawson-Rose ◽

Kellie Freeborn ◽

...

Keyword(s):

Sexual Health ◽

Health Clinic ◽

Community Based ◽

Sex With Men ◽

Exposure Prophylaxis

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864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1059 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S523-S524

Author(s):

Genevieve Allen ◽

Jamie Riddell

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Family Medicine ◽

Hiv Testing ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Providers ◽

Care Providers ◽

Academic Medical ◽

Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

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Follow-up of renal impairment results among attendees taking HIV Pre-Exposure Prophylaxis at a Sydney Sexual Health Clinic

International Journal of STD & AIDS ◽

10.1177/0956462420922751 ◽

2020 ◽

Vol 31 (7) ◽

pp. 689-693

Author(s):

NB Comninos ◽

R Foster ◽

R Varma ◽

C Bourne

Keyword(s):

Renal Impairment ◽

Sexual Health ◽

Service Provision ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Health Centre ◽

Health Clinic ◽

Immunodeficiency Virus ◽

Exposure Prophylaxis

Renal monitoring is recommended for Pre-Exposure Prophylaxis (PrEP) users. We aimed to explore follow-up and outcomes among PrEP users with renal impairment (defined as estimated glomerular filtration rate <65 mL/min/1.73 m2) attending Sydney Sexual Health Centre. Time to follow-up was analysed for impairment results over a 12-month period (January–December 2018); 48/2504 (1.9%) tests among 1700 attendees showed impairment. Follow-up occurred in 39/48 (81.3%) impairment results after a median of 42 days. PrEP was ceased in 3/6 cases of non-resolving/persisting impairment, with one case of subsequent human immunodeficiency virus infection. Maintaining engagement and follow-up of those with renal impairment are important aspects of PrEP service provision.

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A PrEP Information and Self-Screening Tool for Women

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.1.13 ◽

2018 ◽

Vol 30 (1) ◽

pp. 13-25 ◽

Cited By ~ 6

Author(s):

Kate L. Collier ◽

Lisa G. Colarossi ◽

Kimberly Sanders

Keyword(s):

New York ◽

Hiv Prevention ◽

Hiv Risk ◽

Language Use ◽

Service Providers ◽

Self Assessment ◽

Women Studies ◽

Potential Impact ◽

Exposure Prophylaxis ◽

Assessment Questions

Although HIV pre-exposure prophylaxis (PrEP) is effective for women, studies show limited uptake among women to date. Barriers to women's PrEP uptake include their limited knowledge about PrEP and low perceived HIV risk. To address these barriers, we developed and pretested a printed palm card containing HIV prevention/PrEP information that addressed HIV prevention motivation with self-assessment questions about HIV risk. We conducted expert interviews (N = 8), focus groups with health, education, and social service providers (N = 13), and interviews with community women (N = 30) in New York City to assess attention to and acceptability of the card, comprehension of the information, and potential impact on prevention motivation. The card format and content were found to be acceptable and potentially motivational for preventive behaviors, as well as particularly relevant for women. Results of testing for language use, comprehension, and attention guided the final version of the card content.

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