HIV/AIDS has arguably caused the most devastation to the human population, where health, socioeconomic, and institutional barriers have hindered eradication. Therefore, prevention has garnered more relevance throughout the disease’s history showing great promise. Previous studies have shown that use of Pre-Exposure Prophylaxis (PrEP) can reduce HIV incidence at rates over 90%.
This study was conducted in the University of Chicago Medicine’s Adult Emergency Department (ED). Patients with a negative HIV test result or positive sexually transmitted infection (STI) test received telephone counseling. In-person counseling subjects were identified with a point-based electronic algorithm that “flagged” patients with scores of 21 or higher; with data from the electronic medical record the following scoring system was used: Male (7), STI related chief complaint (6), Age 18-20 (13), Age 21-24 (8), Men who has sex with men (14), & Positive STI result within 6 months (21). Patients hospitalized following their ED visit; those with domestic violence, active pregnancies, miscarriages, and/or acute psychiatric illness billing codes; and those who were HIV positive were excluded. PrEP eligibility was determined using the CDC’s PrEP guidelines during a counseling session that included HIV risk assessment, prevention counseling, and determination of willingness to take PrEP. Patients interested in initiating PrEP were referred for a PrEP medical visit. The percentage of patients scheduled for PrEP and who initiated PrEP among those who received the different counseling strategies was compared using Fisher’s exact analysis to determine counseling strategy efficacy.
There was no statistically significant difference in percentage of patients referred to PrEP initiation between those who received telephone vs. in-person counseling (p = 0.58). In fact, a low percentage of both groups were successfully linked to PrEP.
Very few patients in both groups initiated PrEP, suggesting that factors besides counseling strategies play a role in initiating PrEP. Study limitations included low rates of successful telephonic contact, limited availability to provide in-person counseling, patient refusal to receive counseling, and low adherence to initial PrEP appointments.
E. Almirol, None