PrEP: HIV, STI testing underutilized among general practitioners

  • Spinelli MA & al.
  • Open Forum Infect Dis
  • 1 Jun 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Adherence to HIV testing and monitoring/testing for sexually transmitted infections (STIs) before/during follow-up for preexposure prophylaxis (PrEP) is suboptimal among primary care providers.

Why this matters

  • Lack of testing/monitoring among at-risk patients is linked to HIV drug resistance and HIV transmission.
  • Clinical management strategies, particularly those geared toward improving HIV and STI testing, especially in older males, African Americans, and men who have sex with men (MSM), are recommended.

Key results

  • 405 patients, 85% male (median age, 34 years); approximately two-thirds were MSM.
  • HIV and STI testing were ordered only 77% and 81% of the time, respectively.
  • Follow-up HIV testing was ordered in 68% of 4-month intervals, 67% of 6-month intervals.
  • In MSM, extragenital screening was ordered 70% of the time along with urine test.
  • Factors associated with lower HIV testing rates included older patients, males, and prescriptions exceeding 90 days.
  • Lack of timely STI follow-up was associated with African American ethnicity, serodifferent relationships.

Study design

  • Retrospective data analysis of factors associated with provider adherence to PrEP monitoring guidelines in a network of 15 safety net, primary care clinics.
  • Funding: National Institutes of Mental Health.

Limitations

  • Data limitations.
  • Inability to account for out-of-network testing.
  • Limited generalizability.

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