(PL32) 12-MONTH HIV/STI PREVENTION OUTCOMES AMONG PATIENTS DIAGNOSED WITH A SEXUALLY TRANSMITTED INFECTION IN EMERGENCY DEPARTMENTS IN A HIGH-PREVALENCE JURISDICTION

Background:
Diagnosis of a bacterial sexually transmitted infection (STI) is associated with future HIV acquisition. Many patients seeking care in Emergency Departments (EDs) experience barriers to longitudinal sexual healthcare. We sought to describe 12-month HIV/STI prevention outcomes among patients diagnosed with an STI during an ED encounter in a jurisdiction with high HIV/STI prevalence.

Methods:
Retrospective cohort study of adult patients diagnosed with a bacterial STI (gonorrhea, chlamydia, syphilis) 1/1/2021–6/30/2022 at four EDs in the Bronx, NY. Data were extracted from the Einstein-Rockefeller-CUNY Center for AIDS Research Clinical Cohort Database and confirmed by manual review. Outcomes assessed through 6/30/2023 included repeat HIV/STI testing, discussion of HIV preexposure prophylaxis (PrEP), and prescription for postexposure prophylaxis (PEP) or PrEP. We used Chi-squared tests (Fisher’s exact tests when appropriate) and multivariable logistic regression to identify characteristics independently associated with outcomes.

Results:
583 patients not known to be living with HIV were diagnosed with a bacterial STI in the ED. Approximately half were cisgender-women (48% cisgender-men, 1% gender minority), most were non-Hispanic Black (50%) or Hispanic (42%), 90% were 18-39 years old, and 26% had a prior STI. Within 12 months of the index STI, 28% and 36% had repeat HIV and STI testing, respectively, there was one new HIV diagnosis, and 10% re-tested positive for an STI. PEP was prescribed for 1%, PrEP was discussed with 22% and prescribed for 2%. Compared to other genders, cisgender-women were more likely to complete repeat HIV and STI testing (p=.002 and <.0001, respectively); identifying as a gender minority was associated with discussing PrEP (aOR 11.4; 95% CI 1.9, 67.1); and cisgender-men were prescribed PrEP most frequently (89% of those prescribed, p=.05).

Conclusion:
HIV prevention outcomes in this population at high-risk were suboptimal with disparities by demographic characteristics. Strategies are urgently needed to equitably link this population to longitudinal HIV/STI prevention.