A retrospective study of HIV pre‐exposure prophylaxis counselling among non‐Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019

Abstract

Introduction Youth account for a disproportionate number of new HIV infections; however, pre‐exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non‐Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis. Methods We conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient‐ and healthcare‐level factors. Results Four hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth. Conclusions PrEP counselling and uptake among U.S. non‐Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP‐inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.

Provider perspectives on clinical decision support to improve HIV prevention in pediatric primary care: A mixed methods study

“…Almost all had heard about PrEP prior to the study and over one-third self-reported prescribing PrEP. Providers rated the potential use of EHRbased CDS tools to improve HIV testing and PrEP delivery as acceptable (median score 5, IQR [4][5]) and appropriate (5, IQR [4][5]). However, feasibility ratings were slightly lower (4, IQR [3.75-4.75]), with 26% of participants disagreeing that implementation would be "easy to do."…”

“…1,2 Previous analyses have identi ed low HIV testing rates both relative to the overall prevalence of sexual activity and sexually transmitted infections (STI) in adolescents. 3,4 Despite high e cacy, PrEP delivery and counseling rates have also remained low, 2,5,6 even with Centers for Disease Control and Prevention (CDC) guidelines now recommending that all sexually active adolescents should be informed about PrEP. 7 Pediatric primary care, where most adolescents receive their routine care, is an ideal setting for HIV testing and PrEP delivery.…”

Missed Opportunities for HIV Prevention in a Large County Safety Net Health System

“…[12][13][14] Those with a recent bacterial STI (eg, gonorrhea or syphilis) are at increased likelihood of acquiring HIV and are eligible for PrEP, though HIV screening or PrEP prescribing does not often occur. 11,15,16 The overlap of the HIV and STI epidemics is an important aspect of the public health response. Addressing increasing rates of STIs should be concurrently considered as part of HIV prevention strategies.…”

Provider perspectives on clinical decision support to improve HIV prevention in pediatric primary care: a multiple methods study

“…Previous analyses have identified low HIV testing rates both relative to the overall prevalence of sexual activity and sexually transmitted infections (STI) in adolescents [ 3 , 4 ]. Despite high efficacy, PrEP delivery and counseling rates also remain low, with only 16% of youth ages 16–24 with PrEP indications receiving prescriptions [ 2 , 5 – 7 ] despite Centers for Disease Control and Prevention (CDC) guidelines now recommending all sexually active adolescents should be informed about PrEP [ 8 ].…”

“…Data demonstrate that 10% of cisgender females with PrEP indications have been prescribed PrEP compared to 28% of cisgender males [ 25 ]. These inequities may be further magnified in adolescents, with a recent study of adolescents with STIs finding that male sex at birth patients were 26 times more likely than female sex at birth patients to receive PrEP counseling [ 5 ]. Within the pediatric primary care setting, given overall low rates of testing, there is thus a critical need for guideline-based HIV prevention service delivery to youth across sexes, sexual orientations, and gender identities.…”