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

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.

scholarly journals 1529. Sexually-Transmitted Infection Testing and Positivity among Adults Receiving HIV Pre-Exposure Prophylaxis within an Integrated Health Care Delivery System in the United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S765-S765
Author(s):  
Mark A Schmidt ◽  
John F Dickerson ◽  
Suzanne B Schmidt ◽  
Maureen O’Keeffe-Rosetti ◽  
Judy L Donald ◽  
...  
Keyword(s):  
Sexually Transmitted Infection ◽  
Care Delivery ◽  
The United States ◽  
Health Care Delivery System ◽  
Transmitted Infection ◽  
Record System ◽  
Sexually Transmitted ◽  
Sti Testing ◽  
Exposure Prophylaxis ◽  
The Impact

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

Renal and Genitourinary Emergencies

2019 ◽  
pp. 293-303
Author(s):  
Michelle Storkan
Keyword(s):  
United States ◽  
Emergency Department ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Sexually Transmitted Infection ◽  
The United States ◽  
Common Reason ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Tract Infections

Renal and genitourinary complaints are common presentations to the emergency department. Urinary tract infections are among the top three sites of infection in patients presenting to the emergency department. Nephrolithiasis is also a common reason for patients to present due to the severe associated pain. Greater than 20 million patients in the United States are diagnosed with a sexually transmitted infection yearly and many of these present to the emergency department due to the associated discomfort and related symptoms. Other conditions related to the renal and genitourinary systems, though less common, are important for emergency providers to be adept at managing.

scholarly journals Gaps in Sexually Transmitted Infection Screening Among Men who Have Sex with Men in Pre-exposure Prophylaxis (PrEP) Care in the United States

2020 ◽  
Author(s):  
Christina Chandra ◽  
Kevin M Weiss ◽  
Colleen F Kelley ◽  
Julia L Marcus ◽  
Samuel M Jenness
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Sexually Transmitted Infection ◽  
Prevalence Ratio ◽  
The United States ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Exposure Site ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background The US Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3–6 months for men who have sex with men (MSM) using human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified. Methods We used survey data collected from the internet-based ARTnet study between 2017 and 2019 on STI screening among MSM across the United States, stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast, associated with consistent (“always” or “sometimes”) exposure site-specific STI screening during PrEP care. Results Of 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP. Among ever PrEP users, 87%, 78%, 57%, and 64% reported consistent screening for STIs by blood sample, urine sample or urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care. Compared to PrEP users in all other regions, PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], .76–.98) and rectal STIs (aPR, 0.76; 95% CI, .62–.93) during PrEP care. Conclusions Substantial gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeast states where the STI burden is substantial.

scholarly journals Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

2020 ◽  
Vol 19 ◽  
pp. 232595822093976
Author(s):  
Patrick O’Byrne ◽  
Lauren Orser ◽  
Amanda Vandyk
Keyword(s):  
Seroconversion Rate ◽  
Male Partner ◽  
Post Exposure Prophylaxis ◽  
Hiv Status ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Control And Prevention ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis

Patients who use post-exposure prophylaxis (PEP) are at ongoing risk for HIV acquisition after completing PEP. While the Centers for Disease Control and Prevention recommends pre-exposure prophylaxis (PrEP) use immediately after PEP, some practitioners are hesitant to offer PEP-to-PrEP (PEP2PrEP). We began offering PEP2PrEP in the sexually transmitted infection clinic in Ottawa, Canada on August 5, 2018. During the first 16 months of PEP2PrEP, 61 patients requested PEP and 46 were initiated; 30 of these patients agreed to PEP2PrEP and 26 followed through. None of our PEP patients had confirmed HIV exposures; all fulfilled the initiation criterion of condomless anal sex with a male partner of unknown HIV-status. During the study, the number of PEP requests and initiations was statistical unchanged, yet the seroconversion rate among patients who used PEP decreased from 1.7% pre-PEP2PrEP to 0% post-PEP2PrEP. Regarding follow-up, most discontinuations occurred between the PrEP intake and 1-month follow-up visit.

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