2271. Adherence to Pre-Exposure Prophylaxis Is Associated With Sexually Transmitted Infections Among Men Who Have Sex With Men in the Deep South

Abstract

BackgroundPre-exposure prophylaxis (PrEP) reduces HIV acquisition, but there are reports of high sexually transmitted infection (STI) rates among PrEP clients, possibly related to high-risk sexual behaviors (risk compensation). The study objective was to identify the prevalence and facilitators of STIs among men who have sex with men (MSM) at a Deep South PrEP clinic.MethodsThis was a retrospective analysis of MSM aged ≥18 years receiving STI testing at a university-affiliated PrEP clinic in Birmingham, AL from 2014 to 2018. Clients were screened for gonorrhea and chlamydia in the oropharynx, urine, and rectum by nucleic acid amplification test and syphilis by serological testing at least every 6 months. Results of STI testing and biannual patient-reported outcomes (PROs) for condomless anal sex, numbers of sexual partners within the last 3 months, and PrEP adherence were analyzed. The outcome of interest was any positive STI. We evaluated the association of STIs with these PROs using logistic regression.Results141 MSM met study criteria: 29 (21%) were age 18–24, 39 (28%) identified as black, 25 (18%) reported consistent condom use, 22 (17%) reported >7 sexual partners in the past 3 months, 97 (69%) were prescribed PrEP, and 41 (29%) had at least one positive STI test. By univariate analysis, sexual partner number >7 and PrEP adherence were significantly associated with STIs; age and race were not. In multivariable analysis (Table 1), >7 sexual partners and PrEP adherence were independently associated with STI infection.ConclusionIn a university-based PrEP Clinic in the Deep South, STIs were common in MSM. Our findings suggest that risky sexual behaviors among PrEP clients contribute to STIs, especially for those reporting PrEP adherence and high number of sexual partners, and highlight STI prevention opportunities.Table 1:Multivariable Analysis of STIs Among PrEP Clients at a University-affiliated PrEP ClinicWith STI N (%)Odds Ratio (95% CI)Consistent Condom useYes*5 (14)No28 (76)1.6 (0.5–5.2)Number partners/3 months02 (5)3.5 (0.3–38.3)1*5 (13)2–718 (46)1.7 (0.5–5.4)>714 (36)9.7 (2.4–40.2)AdherenceNot on PrEP*7 (17)Missed dose 0–2 weeks ago5 (12)1.2 (0.3–5.1)Missed Dose >2 weeks ago29 (71)4.7 (1.4-15.4) *denotes referentDisclosures All authors: No reported disclosures.