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P425 Capturing missed opportunities for PrEP prescription in patient diagnosed with other STIs
  1. Stephanie Mclaughlin1,
  2. Robert Pitts1,
  3. Farzana Kapadia2,
  4. Richard Greene1
  1. 1New York University School of Medicine, Internal Medicine, New York, USA
  2. 2New York University, Epidemiology, New York, USA


Background Sexually transmitted infection (STI) testing in hospital-based settings represents an opportunity to intervene and prescribe pre-exposure prophylaxis (PrEP) to prevent HIV infections.

Methods Electronic health records of patient visits at NYC Health+Hospitals(H+H)/Bellevue between 1/1/14-7/30/17 were queried for positive STIs (gonorrhea (GC) and chlamydia (CT) & syphilis) results by hospital location and time. Visit data also included: patient demographic characteristics and PrEP prescriptions. Generalized estimating equations using a logit link, to account for repeated within patient measures, were used to explore the relationship between having a medical follow-up visit in ≤30 and ≤90 days following STI testing, which represents an opportunity to provide PrEP prescription, and demographic factors, controlling for key confounders.

Results A total of 1,169 HIV-negative patients with 1+ STI diagnosis contributed 1,275 visits, of whom 700 (58%) were female with mean age of 32 yrs (SD=12.3)] and 532 (42%) were male with mean age of 44 yrs (SD 16.3). The majority of patients were Black (40%) or Hispanic/Latino (50%). In this sample, only 27 patients received PrEP. Overall, chlamydia was the most common (135/11%), followed by syphilis (476/38%) and gonorrhea (135/11%). Two-thirds of patients with a +STI diagnosis originated from the ED (33%) and OB/GYN clinics (32%); an additional 11% were diagnosed in Medicine clinics. 78% of patients did not have follow up ≤30 days after +STI diagnosis. In adjusted analyses, the adjusted OR for follow up ≤30 days after +STI diagnosis was lower for Black patients [0.39 (95%CI 0.21–0.72, p<0.01)] and higher for patients ≥45 years old 2.20 [(95%CI 1.16–4.19, p= 0.02)].

Conclusion STI testing at a major, publicly-funded hospital within NYC H&H is an opportunity to discuss and prescribe PrEP. However, our findings suggest that there are significant missed opportunities for linkage to care after a +STI diagnosis and PrEP initiation, especially in the ED among young Black patients.

Disclosure No significant relationships.

  • ART
  • PrEP

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