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Background: In Rochester, New York the MC STD Clinic provides STD/HIV prevention services with over 12,000 walk-in visits/year. From 11/20/14 – 3/30/16, counseling and linkage to community PrEP services were provided. Since 4/1/16 clinical PrEP services were offered on site. We describe the initial experience with “in house”(IH) PrEP services as compared to the linkage program (LP).
Methods: Medical record review assessed the number of patients receiving PrEP counselling, accepting PrEP services (IN and LP), and attending PrEP appointments. Data regarding race, age, insurance, STD history, HIV/STD results, sexual preference, and barriers to PrEP were also collected and analyzed by descriptive statistics.
Results: From 11/2014-6/2016, 393 pts received PrEP counseling. Prior to IH PrEP, 300 pts underwent PrEP counseling and since IH PrEP, 93 pts received counselling. 131/393 (33%) pts accepted PrEP. Prior to IH PrEP, 88/300 (29%) pts accepted LP referrals. After IH PrEP, 3/93 (3%) accepted LP referral and 40/ 93 (43%) accepted IH PrEP referral. 43/91 (47%) of the LP pts attended their first PrEP appointment. 19/40 (47.5%) IH pts returned for their first PrEP appointment. 13/19 (68%) pts are now receiving PrEP. Insurance was the most frequent barrier to PrEP initiation IH. Notably, 6/393 (1.5%) pts HIV seroconverted. All were male with a median age of 22.5. 2/6 (33%) had accepted PrEP LP. 4/6 pts refused referral. All 6 pts self-identified as bisexual or homosexual. 5/6 (83%) pts were treated for a STD/contact to STD in the past year.
Conclusions: Our experience underscores the need for expedited PrEP therapy in a public STD clinic. More patients accepted IH PrEP referral than LP to PrEP (40/2 months vs 91/19 months). The high rate of HIV seroconversion in PrEP-counselled pts signifies that PrEP counselling at public STD clinics targets a population at high risk. Updated data will be provided in September.