Low HIV incidence among women following sexually transmitted infection does not support national pre-exposure prophylaxis recommendations

Abstract Background The goal of this project was to assess the frequency of sexually-transmitted infection (STI) testing and positivity among adult individuals initiating HIV Pre-Exposure Prophylaxis (PrEP) within Kaiser Permanente Northwest (KPNW). Methods We identified KPNW members, 18 years of age and older, who initiated PrEP (tenofovir+emtricitabine) between January 1, 2015 – December 31, 2018. Using data elements abstracted from the electronic health record system, we assessed demographic characteristics of those initiating PrEP and the rate of testing and positivity for HIV, chlamydia (CT) and gonorrhea (GC) and syphilis within a window around 120 days after PrEP initiation. Results Overall, 685 members initiated PrEP during our study period, 661 (96.5%) of whom were male. Mean and median ages were 38 and 36 years, respectively, with those 25-34 years of age comprising the highest proportion (241; 35.2%). The 460 PrEP initiators (67.2% of total) who continued use beyond 120 days were significantly older than those who discontinued use (39 vs. 36 years, p=0.0008). Among continuous users, 78.3% were tested for CT+GC and 83.9% were tested for syphilis roughly 120 days post-initiation, with positivity proportions of 6.9%, 6.7%, and 2.3%, respectively. Among those discontinuing, 39.6% were tested for CT+GC and 37.3% were tested for syphilis, with positivity proportions of 10.1%, 9.0%, and 2.4%, respectively. HIV testing was completed for 87.4% of continuous PrEP users and 40.9% of those who discontinued use; and we identified a total of three individuals who tested positive for HIV, all among the latter group. Manual chart review of these individuals confirmed that HIV exposure and infection occurred after PrEP discontinuation. Conclusion We found high rates of STI testing among individuals receiving PrEP, in accordance with recommendations. Our findings of a lower STI prevalence among PrEP users is encouraging, although further work is required to assess the impact of differential testing rates and age between those who continue and discontinue PrEP use as well as reasons for PrEP discontinuation. Regular testing remains an important part of comprehensive PrEP care management and should continue to be encouraged to identify and treat STI among those at high risk for disease. Disclosures All Authors: No reported disclosures

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Reliability and Validity of a Free Oral Pre-exposure Prophylaxis (PrEP) Adherence Questionnaire Among Patients with Sexually Transmitted Infection and Without HIV Infection in Shanghai

10.21203/rs.3.rs-73648/v1 ◽

2020 ◽

Author(s):

Xiaoyue Yu ◽

Chen Xu ◽

Yang Ni ◽

Ruijie Chang ◽

Huwen Wang ◽

...

Keyword(s):

Factor Analysis ◽

Hiv Infection ◽

Sexually Transmitted Infection ◽

Roc Curve ◽

Content Validity ◽

Item Analysis ◽

Reliability And Validity ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Exposure Prophylaxis

Abstract Objective: In this study, we aimed to evaluate the validity and reliability of the free oral pre-exposure prophylaxis (PrEP) adherence questionnaire among patients with sexually transmitted infection who do not have HIV infection in Shanghai. Methods: We conducted a cross-sectional study among 816 patients from sexually transmitted infection (STI) clinics in Shanghai. The questionnaire included self-reported demographic characteristics, items on adherence to free oral pre-exposure prophylaxis (PrEP), and PrEP uptake behavior measurement. Item analysis was carried out by calculating the critical ratio and item-total correlations. Internal consistency and split-half reliability were measured to assess reliability. Content validity, construct validity, convergent validity and discriminant validity were measured to assess validity. We conducted logistic regression with receiver operating characteristic (ROC) curve analysis to assess the predictive value of the adherence questionnaire for PrEP uptake behavior. Results: All items were considered acceptable in the item analysis (P<0.05). The questionnaire had a Cronbach’s alpha of 0.757 and split-half reliability of 0.633. The scale-level content validity index (CVI) was 0.938 and the item-level CVI of each item ranged from 0.750 to 1. In exploratory factor analysis, we introduced a four-factor model accounting for 79.838% of the aggregate variance with all factors loading more than 0.4, which was validated in confirmatory factor analysis (c2=47.1, degrees of freedom=14, root mean square error of approximation=0.078). According to regression analysis, adding PrEP adherence questionnaire scores contributed to prediction of PrEP uptake behavior (P<0.001). The maximum area under the ROC curve was 0.778 (95% confidence interval: 0.739–0.817), corresponding to a cutoff score of 9.Conclusion: The PrEP adherence questionnaire generally has acceptable reliability and validity. This questionnaire can be used as a tool to evaluate PrEP adherence in patients with STI who do not have HIV infection.

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Sexually transmitted infection diagnoses, sexualised drug use and associations with pre-exposure prophylaxis use among men who have sex with men in the UK

International Journal of STD & AIDS ◽

10.1177/0956462419897222 ◽

2020 ◽

Vol 31 (3) ◽

pp. 254-263

Author(s):

Matthew P Hibbert ◽

Caroline E Brett ◽

Lorna A Porcellato ◽

Vivian D Hope

Keyword(s):

Drug Use ◽

Sexually Transmitted Infection ◽

Transmitted Infection ◽

Cross Sectional ◽

Sexually Transmitted ◽

Factors Associated ◽

Hiv Test ◽

Condomless Anal Intercourse ◽

Sex With Men ◽

Exposure Prophylaxis

Previous research has focused on acceptability of pre-exposure prophylaxis (PrEP) use, but few community-based studies have been conducted regarding actual use, and PrEP use in the context of sexualised drug use remains understudied. A national online cross-sectional study recruited men who have sex with men (MSM) via social media (April–June 2018). Multivariable logistic regression was used to investigate factors associated with PrEP use. Bivariate analyses compared engaging in condomless anal intercourse (CAI) under the influence of specific drugs and recent sexually transmitted infection (STI) diagnoses (past 12 months) between MSM taking PrEP and those not. Overall, 6% (99/1581) MSM reported current PrEP use. Factors associated with PrEP use were increasing age, recent genitourinary medicine (GUM) attendance (95% versus 45%, aOR = 6.25, 95%CI 2.05, 19.03), an HIV test in the past three months (89% versus 23%, aOR = 14.22, 95%CI 6.76, 29.90), and recent engagement in chemsex (21% versus 4%, aOR = 3.56, 95%CI 1.78, 7.11). MSM taking PrEP were more likely to have had an STI diagnosis (42% versus 8%), most commonly chlamydia (26% versus 3%) and gonorrhoea (25% versus 4%). Considering the elevated levels of self-reported STI diagnoses among those on PrEP, there was a high level of engagement with sexual health services, which may help reduce onward STI transmission.

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Capturing missed HIV pre-exposure prophylaxis opportunities—sexually transmitted infection diagnoses in the emergency department

International Journal of STD & AIDS ◽

10.1177/09564624211048671 ◽

2021 ◽

pp. 095646242110486

Author(s):

Stephanie E Mclaughlin ◽

Farzana Kapadia ◽

Richard E Greene ◽

Robert Pitts

Keyword(s):

Emergency Department ◽

Sexually Transmitted Infection ◽

The United States ◽

Human Immunodeficiency Virus Prevention ◽

Transmitted Infection ◽

Missed Opportunities ◽

Hospital System ◽

Sexually Transmitted ◽

Exposure Prophylaxis

The United States Centers for Disease Control and Prevention (CDC) recommends HIV pre-exposure prophylaxis (PrEP) be considered for all patients diagnosed with a sexually transmitted infection (STI). Emergency departments (EDs) are an important site for diagnosis and treatment of STIs for under-served populations. Consequently, we identified 377 patients diagnosed with a bacterial sexually transmitted infection (gonorrhea, chlamydia, and/or syphilis) at a major New York City emergency department between 1/1/2014 and 7/30/2017 to examine associations between key sociodemographic characteristics and missed opportunities for PrEP provision. In this sample, 299 (79%) emergency department patients missed their medical follow-up 90 days after STI diagnosis, as recommended. Results from adjusted generalized estimating equation regression models indicate that patients >45 yo (aOR = 2.2, 95% CI 1.2–3.9) and those with a primary care provider in the hospital system (aOR = 6.8, 95% CI 3.8–12.0) were more likely to return for follow-up visits, whereas Black patients (aOR = 0.44, 95% CI 0.25–0.77) were less likely to return for follow-up visits. These findings indicate that lack of STI treatment follow-up visits are significantly missed opportunities for PrEP provision and comprehensive human immunodeficiency virus prevention care.

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