The Purview Paradox: PrEP Utilization at a Major Southern California County Teaching Hospital and Affiliated Clinics
Background: The Centers for Disease Control (CDC) report that 18% of people who have indications for HIV Pre-Exposure Prophylaxis (PrEP) in the U.S. are prescribed it, with reporting higher in California (21.9%). We predict that PrEP prescription is lower at Harbor-UCLA Medical Center (HUMC) and affiliated clinics.
Objective(s): Identify the pattern of non-PrEP HIV documentation, PrEP discussion, and new PrEP prescription. Explore provider specialty differences in PrEP discussion and prescription practices.
Methods: A retrospective chart review of HIV-negative patients with ICD-10 coded diagnoses of sexually transmitted infections (STIs) or high-risk sexual behavior was performed across various medical specialties at HUMC and affiliated clinics in 2018. Documentation of non-PrEP HIV counseling, PrEP discussion and prescription was reviewed from electronic medical records for each encounter. Descriptive statistics and unadjusted logistic regression were completed in STATA.
Results: The sample included 250 individual patients, all with indications for PrEP. Of those, 47.2% identified as Latinx and 27.2% Black. Of the 250 individual patients, 87 (34.8%) returned for a 2nd visit, 35 (14.0%) for a third, and 9 (3.6%) for a 4th visit, totaling 381 encounters. Of the total encounters, 49.3% had non-PrEP HIV Counseling, 7.3% had discussions about PrEP with their provider, and only 2.1% were newly prescribed PrEP. OB/GYN providers had no discussions (P value 0.017) or new prescriptions (P value 0.03) of PrEP compared to primary care and acute care providers.
Conclusions: The percent of individuals newly prescribed PrEP (2.1%) at HUMC and affiliated clinics is less than that reported nationally and in California. Primary care providers had a greater proportion of PrEP discussion and PrEP prescription compared to OB/GYN, EM and urgent care when looking at total encounters. Low rates of PrEP discussion and prescription suggest there is further work to be done to understand provider/ system related factors in discussing and prescribing PrEP.