• Melanie G Lopez, Kristin S Alvarez, Michael Harms, Margaret Smith, Levy KamugishaEmilyEFrom the University of Texas Southwestern Medical Center (MGL); Parkland Health, Center of Innovation and Value, University of Texas Southwestern Medical Center (KSA, MH); Department of Family and Community Medicine, University of Texa, Elizabeth Mayfield Arnold, and Helen L King.
• From the University of Texas Southwestern Medical Center (MGL); Parkland Health, Center of Innovation and Value, University of Texas Southwestern Medical Center (KSA, MH); Department of Family and Community Medicine, University of Texas Southwestern Medical Center (MS, ELK); College of Medicine, Department of Psychiatry, University of Kentucky (EMA); Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center (HLK).
• J Am Board Fam Med. 2024 Mar 1; 37 (2): 261269261-269.

IntroductionHIV pre-exposure prophylaxis (PrEP) is effective at reducing HIV transmission. However, PrEP uptake is low for racial and ethnic minorities and women, especially in the Southern US Health care clinicians should be prepared to identify all patients eligible for PrEP, provide counseling, and prescribe PrEP.MethodsRetrospective analysis of persons newly diagnosed with HIV was conducted at a large public health system from January 2015 to June 2021. Interactions with the health system in the 5 years preceding HIV diagnosis were analyzed, and missed opportunities for HIV prevention interventions, including PrEP and condom use counseling, were identified.ResultsWe identified 454 patients with a new HIV diagnosis with previous health system interactions. 166(36.6%) had at least 1 identifiable indication for PrEP: 42(9.3%) bacterial STI, 63(13.9%) inconsistent condom use, or 82(18%) injection drug use before HIV diagnosis. Only 7(1.5%) of patients were counseled on PrEP. Most patients (308; 67.8%) had no documented condom use history in the EHR before diagnosis, a surrogate marker for obtaining a sexual history. Patients who exclusively interacted with the emergency care setting did not receive PrEP education and were less likely to receive condom use counseling.ConclusionMissed opportunities to offer HIV prevention before diagnosis were common among patients newly diagnosed with HIV. Most patients did not have sexual history documented in the chart before their HIV diagnosis. Educational interventions are needed to ensure that clinicians are prepared to identify those eligible and discuss the benefits of PrEP.© Copyright 2024 by the American Board of Family Medicine.

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