Same-day initiation of pre-exposure prophylaxis, or PrEP, for HIV prevention was found to be safe, feasible and well-received among patients at a walk-in STD clinic, according to a recently published study.
During the study, which was conducted at a clinic in Denver, a high proportion of the participants were linked to ongoing PrEP care, researchers reported.
“HIV remains a critical public health priority with almost 40,000 new diagnoses in the U.S. in 2017. PrEP … has demonstrated effectiveness in the prevention of HIV acquisition among men who have sex with men and transgender women, heterosexual individuals, and people who inject drugs,” Kevin F. Kamis, MPH, health programs specialist at Denver Public Health, and colleagues wrote.
“More than 1.2 million persons in the U.S. are estimated to have indications for PrEP, yet fewer than 50,000 individuals initiated PrEP between 2013 and 2015, underscoring the vital need for new strategies to increase PrEP uptake.”
To assess same-day PrEP initiation as a means to increase PrEP uptake, Kamis and colleagues enrolled 100 individuals aged 18 years or older, giving them a free 30-day PrEP starter pack and assigning them a patient navigator to establish ongoing care. They compared individuals who did and did not attend at least one PrEP follow-up appointment within 180 days of enrollment, and conducted client satisfaction surveys after 3 months.
Overall, 78% of participants completed at least one PrEP follow-up appointment and 57% attended at least two follow-up appointments, Kamis and colleagues reported. When they adjusted the findings for race or ethnicity, age, health insurance status and income, they found that only income was positively associated with follow-up appointment attendance, according to the study. Specifically, for each additional $10,000 of income, there was a 1.7-fold increase in attendance odds (95% CI, 1.07-2.66), according to Kamis and colleagues.
The researchers also reported that, among the 54% of participants who completed the satisfaction survey, all of them said they liked the same-day PrEP option.
“Our study suggests STD clinic-based same-day PrEP initiation models are a highly acceptable, feasible, and safe means of PrEP initiation, and a high proportion of individuals initiated via such models link to ongoing care,” the authors concluded. “STD clinics positioned to initiate but not longitudinally manage individuals on PrEP can utilize patient navigation to support PrEP retention at outside clinics. Rapid PrEP start models are promising approaches to addressing the gap between PrEP need and utilization. More research is needed to assess long-term retention among individuals initiating PrEP under rapid initiation models.” – by Caitlyn Stulpin
Demonstration projects, including at my clinic in New Orleans, have implemented same-day initiation of ART for all newly diagnosed HIV patients. This strategy is safe, well-tolerated and leads to earlier viral suppression. It is also a paradigm shift in how we practice. By treating patients the same day they are diagnosed, we demonstrate our commitment to our patient’s health and to ending the HIV epidemic. The authors add to the literature by evaluating same-day PrEP, before labs are drawn, when nested within an STD clinic. This approach was safe, and patients appreciated immediate access. Similarly, New York City presented on the safety and efficacy of same-day PrEP at walk-in sexual health clinics. In that study, there were differences in who was started on same-day PrEP, with women less likely to receive treatment. This study showed a smaller proportion of black participants in the study started same-day PrEP than were seen at the STD clinic. Same-day initiation of ART for treatment of HIV or PrEP is safe and improves health outcomes. Now, we must ensure equity with this approach.
Jason Halperin, MD, MPH
Infectious diseases physician