Addressing Unmet PrEP Needs in Women: Impact of a Laboratory-Driven Protocol at an Urban, Essential Hospital

Author:

Stewart Jessica1ORCID,Ruiz-Mercado Glorimar12,Sperring Heather1ORCID,Pierre Cassandra M1,Assoumou Sabrina A1,Taylor Jessica L32

Affiliation:

1. Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center , Boston, Massachusetts , USA

2. Grayken Center for Addiction, Boston Medical Center , Boston, Massachusetts , USA

3. Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center , Boston, Massachusetts , USA

Abstract

Abstract Background HIV pre-exposure prophylaxis (PrEP) uptake in women remains low. We developed a laboratory result–driven protocol to link women with a positive bacterial sexually transmitted infection (STI) to HIV PrEP at an urban safety-net hospital. Methods Electronic health records of women with positive chlamydia, gonorrhea, and/or syphilis tests were reviewed, and those eligible for PrEP were referred for direct or primary care provider-driven outreach. We assessed the proportion of women with STIs who received PrEP offers, acceptance, and prescriptions before (July 1, 2018–December 31, 2018) and after (January 1, 2019–June 30, 2020) implementation to evaluate changes in the delivery of key elements of the PrEP care cascade (ie, PrEP offers, acceptance, and prescribing) for women with STIs after protocol implementation. Results The proportion of women who received PrEP offers increased from 7.6% to 17.6% (P < .001). After multivariable adjustment, only the postintervention period was associated with PrEP offers (odds ratio [OR], 2.49; 95% CI, 1.68–3.68). In subgroup analyses, PrEP offers increased significantly among non-Hispanic Black (OR, 2.75; 95% CI, 1.65–4.58) and Hispanic (OR, 5.34; 95% CI, 1.77–16.11) women but not among non-Hispanic White women (OR, 1.49; 95% CI, 0.54–4.05). Significant changes in PrEP acceptance and prescriptions were not observed in the sample overall. Conclusions A laboratory result–driven protocol was associated with a significant increase in PrEP offers to Black and Hispanic women with STI. These results provide concrete suggestions for health systems seeking to increase PrEP access and equity among women.

Funder

Massachusetts Department of Public Health Bureau of Infectious Disease and Laboratory Sciences

Office of HIV/AIDS

National Institute on Drug Abuse

National Institutes of Health

Publisher

Oxford University Press (OUP)

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