Background: Post exposure prophylaxis (PEP) is an important tool to prevent HIV acquisition after sexual exposure and an opportunity for care engagement for ongoing prevention of HIV and other sexually transmitted infections (STIs). It is unknown whether prevention services vary by where follow-up care occurs.
Methods: The Mount Sinai Health System (MSHS) supported by the NYC Department of Health and Mental Hygiene instituted a PEP phone hotline for 24/7 access to PEP and subsequent follow-up care. Of the 1231 individual callers to the hotline in 2017, 456 (37%) received follow up care at MSHS and their clinical data were analyzed using logistic regression to examine whether STI testing varied by clinic type (sites that routinely provide HIV/STI care vs. sites that are more general practice).
Results: Of the 456 PEP patients at MSHS, 88% were < 39 years-of-age, the majority identified as male (89%) and LGBTQ (82%), 58% were non-white and 42% were uninsured. At the time of call, almost all were reports of sexual exposures (98%) with 31% and 52% reporting insertive and receptive anal sex, respectively, 65% reporting condomless sex and 29% condom failure, and 40.6% reporting alcohol or drug use around the time of exposure. Nearly 75% sought services at the MSHS Institute for Advanced Medicine (IAM) where comprehensive sexual health services were available as part of routine HIV/STI care. Compared to care at other MSHS facilities, a greater number of those who received care at the IAM were tested for chlamydia (CT), gonorrhea (GC) and syphilis, and STIs were more likely to be detected at IAM sites (p< .05). A multivariable logistic regression controlling for gender and health coverage showed greater odds for having 3-site CT/GC testing at the IAM than at the other facilities (AOR=12.58, 95%CI:6.57-24.08).
Conclusions: Individuals meeting criteria for PEP are at elevated risk for STIs and provision of PEP with linkage to follow-up is an opportunity to engage at-risk individuals in clinical care. When PEP is delivered as part of comprehensive sexual healthcare including multi-site STI testing, otherwise undiagnosed STIs can be identified and treated.

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