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IMMEDIATE PrEP INITIATION AT NEW YORK CITY SEXUAL HEALTH CLINICS
Tarek Mikati1, Kelly Jamison1, Demetre C. Daskalakis1
1New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
New York City (NYC) Sexual Health Clinics (SHC) patients are at increased risk of HIV acquisition. Immediate PrEP initiation (iPrEP) can increase PrEP uptake at walk-in settings where patient visits may be sporadic. At NYC SHC, tenofovir/emtricitabine is offered after a negative rapid HIV test but before results of other lab testing recommended for PrEP initiation are available. PrEP initiation is delayed (dPrEP) if patients report symptoms consistent with acute HIV (AHI), history of kidney disease (KD) and/or history of active hepatitis B virus infection (HBV). We determined the prevalence of PrEP-related medical contraindications among candidates evaluated for iPrEP at NYC SHC.
Using medical record data, we examined demographics and PrEP- related laboratory testing outcomes among patients evaluated for PrEP initiation. Patients were included in the analysis if they were cis-gender men or women, age>18 years, and had no prior HBV serology and serum creatinine testing at NYC SHC. Patients were considered to have PrEP medical contraindications if they had a positive HIV viral load test (absolute contraindication), glomerular filtration rate < 60 ml/min (absolute), and/or a positive Hepatitis B surface antigen (relative).
From January 2017- June 2018, 1437 patients were evaluated for iPrEP; 1387 (97%) qualified and 50 (3%) were delayed. Median age was 28 years (IQR 25-33) and the majority (95%; 1361/1437) were men who have sex with men. Of all 1437 patients, 33% were non-Hispanic (NH) white, 30% Hispanic, and 23% NH Black. One third were foreign born (32%; 456/1437). Inconsistent condom use for vaginal/anal sex in the prior three months was reported by 76% (1059/1437) of patients. The prevalence of any PrEP contraindication was more common among dPrEP than iPrEP patients (14% vs 0.7%; p< 0.001) (see table). Patients ≥ 40 years were more likely to have any PrEP contraindication (3.0% vs 0.5%; p=0.01). PrEP was discontinued within 10 days among iPrEP patients with subsequently identified absolute contraindications (N=4). Among dPrEP patients without any contraindication, only 35% (15/43) initiated PrEP within 60 days. Per protocol, no dPrEP patients with contraindications (N=7) initiated PrEP.
Immediate PrEP initiation is a promising model for walk-in settings; PrEP was rarely discontinued (0.2%) among iPrEP patients due to absolute contraindications. There was a substantial loss to follow up among patients who delayed PrEP due to contraindications concerns.