Get2PrEP: An Electronic Medical Record Laboratory Comment Increased Safe Sex Counseling But Not Preexposure Prophylaxis Services at a Large Urban Academic Medical Center in Northern Manhattan

Abstract

Background: HIV preexposure prophylaxis (PrEP) remains underutilized despite its efficacy and potential population impact. Achieving PrEP's full potential depends on providers who are knowledgeable and comfortable prescribing it to individuals at risk of acquiring HIV. Previous educational interventions targeting provider-related uptake barriers have had limited success. We designed and tested an electronic medical record (EMR) interpretative comment to improve the delivery of PrEP.Methods: An EMR comment provided information on PrEP eligibility and referral resources to providers delivering positive chlamydia and gonorrhea results. Positive test results for bacterial sexually transmitted infections before intervention (January 1, 2019-August 23, 2019) and after intervention (August 24, 2019-December 31, 2019) were identified. A retrospective chart review was conducted to ascertain provider documentation of PrEP discussions or provision, HIV prevention discussions, and HIV screening. Pretest-posttest analysis was performed to compare the provision of PrEP and HIV prevention services. Results:We reviewed 856 preintervention encounters spanning 8 months and 461 postencounters spanning 4 months. Patient demographics were comparable. We observed an increase in provider documentation of safe sex and condom counseling (odds ratios [ORs], 1.2 [95% confidence interval {CI}, 1.07-1.18] and 1.11 [95% CI, 1.05-1.17], respectively), and the absence of any HIV prevention discussion decreased (OR, 0.85; 95% CI, 0.80-0.90), but not HIV screening or PrEP documentation. Conclusions:We demonstrated that an EMR laboratory comment had a modest effect on increasing risk reduction counseling, although not HIV screening or PrEP prescriptions. Future strategies to encourage provider delivery of sexual health services may benefit from more targeted strategies that combine behavioral and information technology approaches.

Get2PrEP2—A Provider Messaging Strategy to Improve PrEP Uptake: A Randomized Controlled Quality Improvement Project

“…Secondary outcomes include documentation of other sexual health counseling indicated by the terms; “safe sex,” “condoms,” or “postexposure prophylaxis.” Safe sex was defined as any form of STI prevention education, whereas condoms included recommending or providing condoms and other forms of barrier protection. This is consistent with prior studies [ 14 ]. It is important to acknowledge that sexual health is moving away from ambiguous, imprecise, and stigmatizing language such as “unsafe” sex or “risky” sex; however, many providers still use the terms and, therefore, we chose to include them in our data analysis [ 18 ].…”

“…The standard of care included the institution's existing CHP, which routinely provides provider education and outreach throughout the institution to increase awareness about available services. Providers had access to the program's information through routine outreach efforts, ongoing advertising, and the interpretive laboratory comment posted below every positive gonorrhea and chlamydia test result in the EMR [ 14 ]. CHP has 5 sexual health navigators available via a phone warm-line (9 Am –5 Pm ) to provide virtual care navigation and assist with linkage to care.…”

“…Building on these findings, in our first Get2PrEP project, we investigated whether adding an electronic medical record (EMR) laboratory comment with PrEP and program contact information to all positive STI results would increase the frequency of PrEP discussions and prescriptions between patients and providers and narrow the gap between men and women. Get2PrEP did not impact PrEP discussions or disparities as hypothesized [ 14 ]. The frequency of PrEP discussions between patients and providers did not differ, and the gap between men and women remained [ 14 ].…”

“…Get2PrEP did not impact PrEP discussions or disparities as hypothesized [ 14 ]. The frequency of PrEP discussions between patients and providers did not differ, and the gap between men and women remained [ 14 ]. These results suggest that additional more active strategies are needed to increase the uptake of PrEP among individuals diagnosed with STIs.…”