Men who have sex with men (MSM) with bacterial sexually transmitted diseases (STDs) are at elevated risk of HIV. We evaluated the integration of pre-exposure prophylaxis (PrEP) referrals into STD partner services (PS) for MSM.
King County, Washington.
Disease Intervention Specialists (DIS) in King County attempt to provide PS to all MSM with early syphilis and, as resources allow, MSM with gonorrhea or chlamydia. Our health department defines MSM with any of the following as at high HIV risk: early syphilis, rectal gonorrhea, methamphetamine/poppers use, sex work, or an HIV-unsuppressed partner. DIS offer high-risk MSM referral to our STD Clinic for PrEP and other MSM referral to community providers. In 2017, we interviewed a random sample of MSM offered referrals in 2016 to assess PrEP initiation after PS.
From August 2014 to August 2017, 7546 cases of bacterial STDs were reported among HIV-negative MSM. DIS provided PS to 3739 MSM, of whom 2055 (55%) were at high risk. DIS assessed PrEP use in 1840 (90%) of these men, 895 (49%) of whom reported already using PrEP. DIS offered referrals to 693 (73%) of 945 MSM not on PrEP; 372 (54%) accepted. Among 132 interviewed for the random sample, men who accepted referrals at initial interview were more likely to report using PrEP at follow-up (32/68 = 47%) than those who did not (12/64 = 19%) (P = 0.0006). An estimated 10.4% of all interviewed MSM initiated PrEP following PS-based referral.
Integrating PrEP referrals into STD PS is an effective population-based strategy to link MSM at high HIV risk to PrEP.
aDepartment of Medicine, University of Washington, Seattle, WA;
bHIV/STD Program, Public Health—Seattle and King County, Seattle, WA;
cWashington State Department of Health, Office of Infectious Disease, Olympia, WA; and
dDepartment of Epidemiology, University of Washington, Seattle, WA.
Correspondence to: David A. Katz, PhD, MPH, Department of Medicine, University of Washington, 325 Ninth Avenue, Box 359931, Seattle, WA 98104 (e-mail: firstname.lastname@example.org).
Supported by the US Centers for Disease Control and Prevention [H25 PS004364]; the Washington State Department of Health; and Public Health—Seattle and King County. The evaluation was also supported by the National Center For Advancing Translational Sciences of the National Institutes of Health [UL1 TR002319] and by the National Institute of Allergy and Infectious Diseases; National Cancer Institute; National Institute of Mental Health; National Institute of Child Health and Human Development; National Heart, Lung, and Blood Institute; National Institute on Aging; National Institute of General Medical Sciences; and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health [P30 AI027757].
Presented in part at the 2017 Conference on Retroviruses and Opportunistic Infections; February 15, 2017; Seattle, WA, and the 2018 Conference on Retroviruses and Opportunistic Infections; March 4–7, 2018; Boston, MA.
M.R.G. has received research support from Cempra Pharmaceuticals and Melinta Therapeutics. J.C.D. has conducted research supported by grants to the University of Washington from Hologic, Quidel, and ELITech and received travel support to a conference supported by Gilead. The remaining authors have no conflicts of interest to disclose.
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Received August 14, 2018
Accepted October 26, 2018