Gaps in Sexually Transmitted Infection Screening Among Men who Have Sex with Men in Pre-exposure Prophylaxis (PrEP) Care in the United States

Abstract

Background The U.S. Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3–6 months for men who have sex with men (MSM) using HIV preexposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified. Methods We used survey data collected from the internet-based ARTnet study between 2017 and 2019 on STI screening among MSM across the U.S., stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast, associated with consistent (“always” or “sometimes”) exposure site-specific STI screening during PrEP care. Results Of 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP. Among ever PrEP users, 87%, 78%, 57%, and 64% reported consistent screening for STIs by blood sample, urine sample or urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care. Compared to PrEP users in all other regions, PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], 0.76–0.98) and rectal STIs (aPR, 0.76; 95% CI, 0.62–0.93) during PrEP care. Conclusions Substantial gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeast states where the STI burden is substantial.

Changes in Sexual Behavior, PrEP Adherence, and Access to Sexual Health Services Because of the COVID-19 Pandemic Among a Cohort of PrEP-Using MSM in the South

“…However, it is not clear whether these findings relating to STD and HIV testing are unique to the pandemic because studies before the pandemic have also found imperfect compliance to STD and HIV testing guidelines for PrEP users. 15,16 Moreover, the pandemic's influence on PrEP use itself is inconclusive; a fifth of participants either indicated they discontinued PrEP use or changed how often they take PrEP because of COVID-19, but there were minimal changes in the number of missed PrEP doses among those who remained on PrEP across periods.…”

HIV, STI and renal function testing frequency and STI history among current users of self-funded HIV pre-exposure prophylaxis, a cross-sectional study, Germany, 2018 and 2019

“…The difference to our results might be due to differences in data capture and healthcare systems. A US survey showed that regular STI screening was offered to 57–87% of PrEP users depending on the sampling location [ 19 ]. In a survey from the United Kingdom, self-reported HIV/STI testing frequencies were high among PrEP users in a trial or a PrEP programme but lower for users sourcing PrEP privately (HIV: 58% reported ≥ 3 tests/year; STI: 48% reported ≥ 3 tests/year) [ 23 ].…”

“…Few studies have investigated testing frequencies outside structured PrEP programmes. Data from surveys and insurance claims indicate considerable differences between guideline recommendations and actual testing frequencies [ 19 - 23 ]. Using PrEP from informal sources (i.e.…”

HIV and Sexually Transmitted Infection Epidemic Potential of Networks of Men Who Have Sex With Men in Two Cities

“…Higher STI case rates in San Francisco may reflect increased screening for STIs among PrEP users. 28 However, recent modeling has suggested that PrEP STI screening could decrease STI incidence through this improved case detection. 29…”