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Quality of care for pre-exposure prophylaxis (PrEP) against HIV is low nationally. Most providers fail to meet guideline-recommended testing, highlighting a need for improved training and interventions to ensure patient safety.

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Area of Science:

  • Public Health
  • Infectious Disease Prevention
  • Health Services Research

Background:

  • Pre-exposure prophylaxis (PrEP) guidelines exist to ensure safe and effective use, particularly for individuals with renal dysfunction or high HIV risk.
  • While PrEP usage trends are documented, national data on guideline compliance, quality of care, and provider factors influencing quality are limited.

Purpose of the Study:

  • To assess compliance with PrEP testing guidelines among healthcare providers in the United States.
  • To evaluate the quality of PrEP care nationally.
  • To identify provider-level factors associated with high-quality PrEP care.

Main Methods:

  • Retrospective claims analysis of commercially insured new PrEP users from January 1, 2011, to December 31, 2019.
  • Inclusion of data from 4200 providers.
  • Logistic regression used to analyze associations between provider characteristics and quality of care.

Main Results:

  • Overall quality of care was low; only 6.4% of providers met ≥60% of guideline-recommended testing.
  • Over 50% of providers lacked claims for HIV testing at PrEP initiation, and ≥40% lacked claims for STI testing at initiation and follow-up.
  • Providers with a single PrEP patient showed higher quality of care (aOR 0.47) compared to those with multiple patients.

Conclusions:

  • Significant gaps exist in adherence to PrEP testing guidelines, indicating suboptimal quality of care nationally.
  • Provider type was not associated with high-quality care, but patient volume may play a role.
  • Interventions, including enhanced training and integrated electronic health record test ordering, are crucial to improve PrEP care quality and patient monitoring.