Missed Opportunities to Initiate Pre-exposure Prophylaxis in South Carolina—2013–2016

Abstract

BackgroundPrEP, regular use of antiretroviral medications by HIV-negative individuals to prevent new HIV infections, has not been widely adopted by some young, high-risk populations. This study investigated the characteristics and estimated percentage of newly diagnosed HIV-infected individuals in South Carolina (SC) who had visited a health care facility (HCF) while HIV-negative and missed opportunities for initiating PrEP.MethodsWe used a unique person-level identifier to link case reports from the SC enhanced HIV/AIDS Reporting System and records from a statewide all payer HCF database. The HCF data include inpatient (IP), outpatient (OP), and emergency department (ED) visits to SC facilities. Because the Food and Drug Administration approved PrEP in 2012, we analyzed data for individuals diagnosed with HIV during January 2013–September 2016 with initial CD4 count ≥500 cells (recent infection) and HC visits during 2011 through the date of diagnosis. We used the two-tailed chi-square statistics with a significant threshold of P < 0.05 in SAS to investigate the association between the absence of a PrEP prescription and patient factors including demographics, behavioral risk, visit setting (IP, OP or ED), frequency of previous visits, and residence at diagnosis.ResultsA total of 785 patients were diagnosed with recent HIV infections (initial CD4 ≥500 cell) during January 2013–September 2016. Of these, 504 (64.2%) visited an SC HCF at least once before being diagnosed, 72.4% were males, 52.4% aged <30 years, 54% were men who have sex with men (MSM) or injection drug users (IDU) and 70.2% resided in urban areas. Mean number of HCF visits before HIV diagnosis was 6.6; 84.3% had ED visits; 5.9% had IP visits; and 7.0% had OP visits. Persons of female sex, Black race, younger age and urban residence were more likely to access HCF visit before HIV diagnosis (P < 0.05).ConclusionWe now know the characteristics and percentage (64.2%) of persons with recent HIV infections captured in two large state-wide databases in SC who missed opportunities to be screened and initiated PrEP during visits to HCFs before HIV diagnosis during 2013–2016.Disclosures All authors: No reported disclosures.