51. Unmet Need For Risk Reduction Counseling And Prep Among Young Women At Risk For HIV

Abstract

Pre-exposure prophylaxis (PrEP) for HIV can reduce acquisition up to 96%. Women currently account for 20% of new HIV infections in the United States. The Centers for Disease Control and Prevention (CDC) recommends HIV counseling and testing services (CTS) for sexually active women diagnosed with a bacterial sexually transmitted infection (STI), and that PrEP be offered to women who have an HIV-positive sexual partner, engage in injection drug use (IDU), or who inconsistently use condoms with a partner of unknown HIV status. The purpose of this study is to evaluate provider sexual risk reduction counseling behaviors and adherence to HIV CTS and PrEP education/prescription guidelines. Data was extracted from the Women’s BioHealth Study, a longitudinal study of young women aged 13-29 years seeking routine gynecologic or obstetric care in pediatric, adolescent medicine, and obstetrics/gynecology clinics within a large academic medical center in Baltimore, Maryland. The STIs considered were Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV). Patients provided demographic and sexual risk data at baseline through a self-reported questionnaire and were notified of results. Eligibility criteria for inclusion in this analysis was: 1) a prior negative HIV test and 2) diagnosis of a bacterial STI, self-reported injection drug use, having an HIV seropositive partner, or inconsistent condom use with a partner of unknown HIV status. Assessment of documented provider HIV and STI risk reduction counseling behaviors were gathered from the Electronic Medical Record (EMR) using a standardized data extraction form. Descriptive statistics and logistic regression analyses were performed. Of the 688 patients enrolled, 23% (N=159) were positive for an STI (CT 10%, NG 5%, TV 38%, MG 62%). Among HIV-seronegative patients, 145 were eligible for PrEP counseling based on diagnosis of a bacterial STI (N=145) and/or self-reported injection drug use (N=3). Of the women eligible for PrEP intervention (N=145), the mean age was 21.5 years (SD 3.6), 92% were African American, 90% reported having one male partner, 6.9% reported consistent condom use, and 41% (N=60) were pregnant. STI treatment was documented for 55% of pregnant women and 80% of non-pregnant women. Non-pregnant women had 84.4 times the odds of receiving general risk reduction counseling compared to pregnant women (OR 84.4; 95% CI: 27.9, 255; p<0.001). Non-pregnant women under the age of 25 had 136 times the odds of receiving risk reduction counseling as compared to pregnant women over the age of 25 (OR 136; 95% CI: 34.08, 542.41; p<0.001). Only one woman (0.69%) eligible for PrEP counseling was offered PrEP. Young women seeking routine gynecologic and obstetric care have an unmet need for STI and HIV CTS and are rarely offered PrEP counseling. Pregnant women are particularly vulnerable for non-receipt of sexual risk reduction counseling and HIV CTS services and should be a targeted for intervention given the potential impact of recurrent or untreated STI diagnosis (including HIV) on maternal-child health outcomes.