HIV Risk and Pre-Exposure Prophylaxis Eligibility Among Emergency Department Patients

Abstract

Our objective was to estimate the prevalence of pre-exposure prophylaxis (PrEP) eligibility, characterize selfperceived and quantified human immunodeficiency virus (HIV) risk, and assess PrEP knowledge and receptiveness of initiating PrEP among emergency department (ED) patients. We performed an IRB-approved crosssectional study from two urban EDs. Patients were eligible if ‡18 years of age and not known to have HIV. Research staff obtained verbal consent and used a structured 29-item instrument to assess HIV risk, PrEP eligibility based on 2017 Centers for Disease Control and Prevention (CDC) guidelines, and general PrEP knowledge among unselected and enriched patient samples, the latter informed by the Denver HIV Risk Score (DHRS). We enrolled 1002 patients with a median age of 39 years; 54.8% were male, 30.9% White/non-Hispanic, 29.5% Black/non-Hispanic, and 22.5% Hispanic. In the full cohort, 119 [11.9%, 95% confidence interval (CI): 9.9-14.0%] were PrEP eligible, and among the unselected cohort, 36 (7.1%, 95% CI: 5.1-9.8%) were PrEP eligible. Using the DHRS, 100 patients were considered ''high risk'' with 32 (32.0%) reporting zero perceived risk. Correlation between the DHRS and self-perceived HIV risk was low (r = 0.13). Of the full cohort, 203 (20.3%) had heard of PrEP, and of these, 33 (16.3%) were PrEP eligible with 25 (75.8%) willing to start PrEP immediately. Yet, of the 119 patients who were PrEP eligible, only 34 (28.6%) had heard of PrEP. In summary, among a heterogeneous ED population, there was discordance in self-perceived and quantified HIV risk. HIV PrEP eligibility was *7% with the highest eligibility among those identified as DHRS ''high risk.'' A significant opportunity exists to identify and initiate PrEP among ED patients.

Perceptions on HIV Pre-Exposure Prophylaxis Among Urgent Care Clinicians in the Southern United States

“…This viewpoint was corroborated in our survey results, with nearly all responding clinicians in this study reporting they are comfortable with managing STI care. In addition, UC clinics serve a population similar to Emergency Departments, which prior studies have described as a prime location for PrEP implementation [ 14 - 16 ]. Yet, in a prior study, UC clinicians had many concerns, including managing side effects of PrEP, adherence to medication, and increased PrEP-associated high-risk sexual behavior [ 17 ].…”

Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

“…The ED prevention navigator actively referred patients interested in outpatient prevention services within a network of local federally qualified health centers (FQHC) identified from the East Bay Getting to Zero collaborative. 16 The ED prevention navigator assisted interested patients at higher risk for acquiring HIV by arranging outpatient linkage to HIV prevention services, working directly with navigators at partnering FQHCs. Navigators tracked the outcomes of these referrals through a combination of EHR review and telephone follow-up with patients and the outpatient clinics.…”

“…The risk survey has been previously described and included questions adapted from the 2017 CDC guidelines for PrEP, as well as 2 site-specific risk factors, sex while using stimulants in the past 6 months and requesting PrEP after meeting with the prevention navigator in the absence of other reported risk behaviors. 15,17 Patients reporting ≥1 risk behavior elicited in the survey were categorized at higher risk for acquiring HIV, all others were categorized at lower risk for acquiring HIV (see Table, Supplemental Digital Content, http://links.lww.com/QAI/C264).…”

Development of a Mobile App to Increase the Uptake of HIV Pre-exposure Prophylaxis Among Latino Sexual Minority Men: Qualitative Needs Assessment

“…In this study, the Latino SMM reported substantial social and structural barriers to PrEP uptake. Some of these barriers, including low perceived PrEP eligibility [36][37][38][39], intersectional stigma [40][41][42] (HIV, gay, and PrEP related), lack of insurance [43] or perceived cost [44], and PrEP misconceptions [45], are shared with other non-Latino groups (albeit with added complexities). Other barriers were more specific to the lives of Latino SMM.…”