Linking emergency department patients at risk for human immunodeficiency virus to pre-exposure prophylaxis

The objective of this study is to describe an Emergency Department (ED)-based, HIV prevention and navigation program and the individuals linked to an in-house clinic for HIV pre-exposure prophylaxis (PrEP) in the first eleven months of program implementation.

This is a retrospective, observational study of an ED-based HIV prevention and navigation program between January 1, 2019, and November 30, 2019. A status neutral navigation program is housed in the ED with 2-3 navigators staffing approximately 80 h per week. Navigators provide HIV screening with point-of-care testing, sexual health education and counseling, including PEP and PrEP information, and HIV risk assessments. They also make follow-up appointments, appointment reminder calls, and offer to accompany individuals to an in-house HIV clinic for clients who either test positive in the ED for HIV, are known to be living with HIV but are out-of-care, are HIV negative but require post-exposure prophylaxis (PEP) and/or meet criteria for and are interested in starting PrEP. Clients are approached if they request HIV or other sexually transmitted infection testing, present to the ED with genitourinary complaints, or are referred to the program by ED medical providers. Funding for the program is from a New York City Department of Health (NYCDOH) service grant. Data were manually abstracted from program records and from a NYCDOH database. The primary study outcomes are how many clients accepted clinic referral for PrEP, attended their appointments, and received a prescription for PrEP.

In the time-period reviewed, complete demographic data and CDC risk factors for HIV were available for 1174 patients. Our program provided appointments for 22 patients who met CDC criteria for PrEP and expressed interest in initiating PrEP. Thirteen patients who attended their scheduled appointment had same day appointments at the on-site clinic, and 11 (85%) were prescribed PrEP. From 1024 paper records with complete data, 914 clients reported that they do not consider themselves at risk for HIV infection.

Most clients that were both eligible and interested in PrEP were prescribed PrEP if given a same day follow-up appointment. Of the clients engaged in this navigation program, almost 80% did not perceive that they were at-risk for HIV infection.