HIV PrEP Eligibility Among Patients Visiting Emergency Departments

A large subgroup of patients visiting emergency departments (EDs) are eligible for HIV pre-exposure prophylaxis (PrEP), making EDs a compelling setting for efforts to expand HIV PrEP, according to results of a study published in The American Journal of Emergency Medicine.

A single-center, cross-sectional study extrapolated PrEP criteria from Centers for Disease Control and Prevention (CDC) recommendations and applied them to 3 existing datasets: a study of consecutively approached patients who visited an ED from 2008 to 2009, patients who participated in an ED’s HIV screening program in 2017, and electronic health record (EHR) diagnostic codes in 2017. These datasets mimicked the patient selection strategies for HIV screening of nontargeted screening, risk-targeted screening, and EHR selected screening.

Among the 1970 patients in the consecutively approached dataset, 568 (28.8%; 95% CI, 26.9-30.9) were eligible for PrEP. Among the 3884 patients who participated in the ED’s HIV screening program and the 66,287 patients who were part of the EHR review sample, 552 (14.2%; 95% CI, 13.1-15.4) and 605 (0.9%; 95% CI, 0.8-1.0) were eligible for PrEP, respectively. The consecutively approach sample and the ED screening sample included behavioral risk data that demonstrated 24 and 82 men, respectively, who have sex with men in each dataset. Of these, 24 (100%) and 64 (78%) were eligible for PrEP. Among heterosexual men and women, 548 of 1467 (37%) in the consecutively approached group and 448 of 2118 (21%) in the risk-targeted screening sample were eligible for PrEP. For people who inject drugs, 18 of 28 (64%) in the consecutively approached sample and 143 of 216 (66%) in the ED screening sample were eligible for PrEP.

The results from this single center study cannot be fully generalized to all settings. Further study limitations include limited data accuracy from existing datasets and the adaptation of CDC PrEP eligibility criteria to them, that high-risk patients may have already been tested and therefore not offered or declined testing in the risk-targeted sample, and limited availability of risk information in the EHR sample.

The researchers conclude that these results are “an initial foundation for estimating the volume of potential ED PrEP intervention and should strongly motivate health services research, analogous to efforts in ED-based HIV screening and linkage to care, to determine whether and how EDs can assist in the national effort to expand PrEP implementation.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Faryar KA, Ancona RM, Braun RS, Brown JL, Sickles RK, Lyons MS. Estimated proportion of an urban academic emergency department patient population eligible for HIV preexposure prophylaxis. Am J Emerg Med. Published online May 4, 2021. doi:10.1016/j.ajem.2021.04.087