Knowledge, Practices and Attitudes of Youth Providers about STI, HIV Testing, and PrEP
In 2015, over half of sexually transmitted infections (STI) and 22% of new HIV infections were among youth aged 15-24. Latest Utah data from 2014 showed this group accounted for 62% of chlamydia, 33% of gonorrhea and 12% of new HIV infections. HIV testing in Utah is low with 24.2% of adults ever tested. There have been no studies published evaluating Utah HIV testing rates in youth.
An anonymous email-based survey was sent to 396 youth providers in Utah during an eight-week span in 2017. 102 (26%) responded and analysis was limited to 83 (21%) providers who reported caring for patients aged 15-24.
The median age of providers was 35.5; median years out of residency 8.5; most were female (54%); self-identified as Caucasian (86%); attending level physicians (70%) and many (61%) practiced in urban settings. Over half identified as moderately, very, or extremely comfortable screening for HIV. Approximately 75% were familiar with CDC HIV testing guidelines. However, only 16% report always or often testing youth for HIV. Providers were more likely to screen for HIV in older patients; 19% always or often screening patients age 17-24 and 10% of patients age 13-16. Factors that increased the likelihood of offering an HIV test included: patient request, men who report sex with men, prior STI or a history of injection drug use (Figure 1). Common reasons for rarely or never offering testing included: belief the patient panel is not sexually active, low prevalence of HIV and provider discomfort in discussing sexual behaviors (Figure 2). Less than one-third of providers reported familiarity with the CDC’s PrEP guidelines, but most (91%) expressed interest in more information. Provider discomfort in offering PrEP was highest in the younger patients (Figure 3). The same factors that increased the likelihood of testing for HIV held true for prescribing PrEP.
In Utah, the majority of providers are familiar with CDC HIV testing guidelines; however, testing remains low. This may be due to misconceptions around HIV risk and provider comfort. This is a missed opportunity for early detection of HIV in a population with known high rates of other STIs. Youth providers are not familiar with PrEP but they would like further education.
M. Schwarz Josten,