Acceptance of HIV pre-exposure prophylaxis (PrEP) referral among a sample of PrEP-eligible emergency department patients

Kiran A Faryar; Robert Braun; Rachel M Ancona; Caroline Freiermuth; Michael S Lyons

doi:10.1016/j.ajem.2022.07.055

Acceptance of HIV pre-exposure prophylaxis (PrEP) referral among a sample of PrEP-eligible emergency department patients

Am J Emerg Med. 2022 Oct:60:152-155. doi: 10.1016/j.ajem.2022.07.055. Epub 2022 Aug 1.

Authors

Kiran A Faryar¹, Robert Braun², Rachel M Ancona², Caroline Freiermuth³, Michael S Lyons⁴

Affiliations

¹ Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267, USA. Electronic address: Kiran.Faryar@UHhospitals.org.
² Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267, USA.
³ Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA.
⁴ Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267, USA; Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, PO Box 670559, Cincinnati, OH 45267, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave., Cincinnati, OH 45267, USA.

PMID: 35973343
DOI: 10.1016/j.ajem.2022.07.055

Abstract

Objective: Pre-exposure prophylaxis (PreP) reduces the rate of HIV transmission in high-risk groups. Emergency departments (EDs) frequently encounter patients at risk for HIV acquisition who are eligible for PrEP. ED HIV screening programs have prioritized testing and linkage to care for patients who test positive, but fail to refer HIV-negative patients to PrEP clinicians. Our objective was to estimate referral acceptance to a PrEP clinician among a sample of at-risk ED patients.

Methods: This single-center cross-sectional study electronically queried a prospectively acquired dataset of survey responses from a sample of patients presenting to an urban academic ED from March 2019 to February 2020. Patients completed a risk assessment as part of the HIV screening program. PrEP eligibility was based off survey responses in accordance with 2017 CDC PrEP eligibility criteria. Identified PrEP-eligible patients completed a PrEP questionnaire. The primary outcome was the proportion of PrEP-eligible patients who accepted referral to a PrEP clinician during their ED encounter. We secondarily report patient participant characteristics including the proportion of PrEP-eligible patients who were aware of and were knowledgeable about PrEP as a method to prevent transmission of HIV.

Results: In total, 360 patients completed a PrEP questionnaire, of which 287 (80%) were not currently taking PrEP and eligible for PrEP referral. 57% were males, with 41% Black/African American. Of the 287 eligible for PrEP, 61 (21.3%, 95% CI: 16.8-26.5) indicated awareness of PrEP, of which, 49 (80.3%, 95% CI: 67.8-89.0) demonstrated accurate knowledge of PrEP. PrEP referral was offered to 238 (82.9%, 95% CI: 78.0-87.0) patients, of which, 76 (31.9%, 95% CI: 26.1-38.3) accepted.

Conclusions: Approximately one third of PrEP-eligible ED patients accepted PrEP referral during their ED encounter, demonstrating an opportunity for increased PrEP education and intentional referral for eligible patients. Variability in PrEP acceptability by demographic and risk subgroup may be an important consideration in efforts to expand PrEP utilization.

Keywords: Emergency department; HIV; PrEP acceptance; PrEP referral; Pre-exposure prophylaxis.

MeSH terms

Anti-HIV Agents* / therapeutic use
Cross-Sectional Studies
Emergency Service, Hospital
Female
HIV Infections* / drug therapy
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Male
Pre-Exposure Prophylaxis*
Referral and Consultation

Substances

Anti-HIV Agents