P-315. Missed Opportunities for Pre-Exposure Prophylaxis Initiation in Persons with Newly Diagnosed HIV Infection at Henry Ford Health

TL;DR

This study found that many people newly diagnosed with HIV in Detroit missed chances to start PrEP, a preventive treatment, despite having risk factors like prior STIs.

Contribution

The study highlights missed opportunities for PrEP initiation in newly diagnosed HIV patients, emphasizing the need for improved preventive strategies.

Findings

88% of HIV diagnoses occurred in the emergency department, with 34% of patients lost to follow-up.

Only 2 out of 14 individuals with a prior STI were offered PrEP, showing significant missed opportunities.

Despite multiple healthcare interactions, most patients had no discussion about PrEP.

Abstract

HIV prevalence in Michigan continues to increase as the number of new diagnoses exceeds the number of deaths, with the highest rates occurring in Detroit. In Michigan, PrEP uptake is determined as low to medium, resulting in HIV diagnoses declining by 0.9% as compared to 8% in states with high PrEP uptake. HIV screening initiatives such as HIV testing in emergency departments (EDs) are effective in new case identification; however, opportunities for PrEP initiation are missed. The aim of this study was to identify missed opportunities for the use of PrEP in newly diagnosed persons with HIV (PWH).Table 1:Descriptive analysis of the patient populationTable 2:Descriptive analysis of persons who met criteria for PrEP due to prior STI

Descriptive analysis of the patient population

Descriptive analysis of persons who met criteria for PrEP due to prior STI

This was a retrospective observational study of adults with newly diagnosed HIV at Henry Ford Health in Detroit, Michigan from 1/1/2024 to 8/1/2024. Testing indications in the ED included sexually transmitted infections (STI) or an ED screening initiative where a best practice alert prompted the providers to order a HIV screening test for individuals 18-65 years without a previous HIV test. Electronic health records were reviewed to collect demographic and clinical data.

Thirty-three individuals with a new HIV diagnosis were included. Demographics are seen in Table 1. The majority (88%) of diagnoses were made in the ED with the highest rates of incidence in Wayne County. Median baseline CD4 cell count was 281 cells/mm3; 9% of individuals had an opportunistic infection. Median time to first HIV appointment and ART initiation were 9 and 8 days in 66% of individuals. However, 34% individuals were lost to follow up. None of the individuals were actively on PrEP; 14 had a prior STI and only 2/14 were offered PrEP. Table 2 shows a descriptive analysis of individuals eligible for PrEP.

While we have made progress in screening for HIV and linking newly diagnosed PWH to care, providing PrEP for HIV to prevent infection has not progressed as evidenced by our study. Despite multiple interactions with healthcare systems a significant majority had no discussion about PrEP. These missed opportunities underscore the need for increased efforts to provide high risk populations with tools including PrEP to reduce risk for HIV infection. To achieve this goal, innovative strategies to prevent new HIV infections are needed, including telePrEP and increased primary care outreach.

Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria

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