Abstract Body

Recent studies suggest that early HAART initiation and PrEP could decrease HIV incidence, but the measurement of impact in primary care settings has been limited.

Fenway Health (FH), the largest10 care center for men who have sex with men (MSM) in Massachusetts (MA) has used an electronic medical record since 1997(CentricityTM), facilitating analyses of secular trends related to HIV census, HAART use, PrEP initiation and incident STDs. Time trend analyses were performed using Spearman’s rank test for correlation and pairwise comparisons were made with Fisher’s exact chi-square test.

Between 2004 and 2014, HIV+ pts in 10 care at FH increased from 1083 to 2101 (p<0.001). In 2004, 922 HIV+ pts were newly diagnosed in MA, compared to 698 in 2013 (p<0.001), and the % MA HIV+ diagnosed at FH increased from 6% to 14%. At FH, 58 pts initiated HAART in 2004 and 121 in 2014 (p<0.001). The median CD4 at the time of HAART initiation was 238 cells/mm3 in 2004, and 464 in 2014 (p<0.001). In 2004, 68% of newly diagnosed pts initiated HAART within the first year of care, compared to 97% in 2014 (p<0.001). During the same period, the % of virologically suppressed pts rose from 57 to 86% (p<0.001) (with 88% suppression among those using HAART). PrEP was first used by 5 pts outside of a clinical trial in 2011, while in 2014, 537 pts initiated PrEP (p<0.001), and in 2015, 589 began PrEP (as of 8/31), with more than 83% of PrEP initiators still using PrEP. Between 2011 and 2015, 5 MSM pts who initiated PrEP became HIV+ (<0.5%) compared to 93 (~2.2%) of more than 4,000 HIV- MSM who did not use PrEP (p=0.006). In 2005, 162 pts were diagnosed with syphilis or rectal or urethral gonorrhea (GC) or chlamydia (CT), while in 2014, 1145 pts tested + for at least one infection (p<0.001); and as of 8/31/15, it was 918. Since 2005, 1/2 of new syphilis diagnoses were in HIV+ patients, while 80% of incident GC/CT infections were in HIV- MSM. More than one third (36%) of MSM who initiated PrEP in 2014 had a recent bacterial STD.

While the HIV+ census at FH has increased over the past decade, earlier treatment initiation has been associated with improved virologic suppression. PrEP use has significantly increased among HIV- MSM, and HIV incidence appears lower in PrEP users than non-users. But, bacterial STD rates significantly increased for HIV+ and – MSM. HIV spread may be slowing among MA MSM, but ongoing screening for bacterial STDs is required, given their significant co-prevalence.